Pediatric Pulmonary Contusion

Etiology: blunt thoracic trauma to alveoli with alveolar hemorrhage
Imaging: patchy airspace opacities with ill defined borders and non-segmental distribution, seen immediately on CT, can take 6 hours to appear on CXR, starts to clear in 1-2 days and resolves by 3-10 days, may develop a pneumatocele, CXR underestimates amount of lung injury present compared to CT
DDX: opacities appearing > 1 day after trauma – aspiration, pneumonia, fat embolus

Radiology Cases of Pulmonary Contusion

CXR and CT of pulmonary contusion — CXR AP shows patchy airspace disease in the right upper lobe which is much better seen on the axial CT with contrast of the chest.

CXR and CT of rib fracture and pulmonary contusion — CXR AP shows cortical irregularities of the right 6th and 7th ribs and no evidence of lung injury. Axial CT of the chest shows a large amount of airspace disease in the right lower lobe and a very small amount of free air anteriorly in the right hemithorax.

CXR and CT of pneumothorax and pulmonary contusion and rib fracture — CXR AP shows a widened mediastinum and a small right-sided pneumothorax. Axial CT with contrast of the chest with lung (above) and bone (below) windows shows air in the pleural space anterior to the right lung and fluid in the pleural space posterior to the right lung as well as airspace disease in the right lower lobe and a cortical disruption through one of the right ribs posteriorly.

CT of chest tube malposition with chest tube in the lung parenchyma — Axial and coronal and sagittal CT with contrast of the chest shows a large amount of air in the left pleural space. The left chest tube is clearly located within the air space disease in the posterior left lung parenchyma in all three planes.