ECMO-/ECLS

injury after major blunt chest trauma, occurring in up to 48% of all pediatric
thoracic trauma patients. The most common causes of pulmonary contusions
are motor vehicle accidents, pedestrian accidents, and falls. Due to the
compressibility of the pediatric chest wall, external signs of chest injury may be
completely absent on physical exam. Patients may, however, present with
clinical signs of respiratory insufficiency including tachypnea, increased work of
breathing, or acute oxygen desaturation. Clinical history, mechanism of injury,
and a high degree of suspicious should prompt a screening chest radiograph.
Chest x-ray findings include the presence of non-anatomic areas of
consolidation or opacification in the area of the lung fields. Pulmonary
contusions may have delayed clinical and radiographic presentation, as injured
parenchyma, edema, and atelectasis blossoms over a 6 hour period. Thus, an
initial normal chest x-ray does not completely exclude pulmonary contusion.
Patients who have concern for this injury should be continually reassessed and
a repeat chest x-ray should be done 6 hours from the initial study for interval
change. CT scan of the chest is rarely necessary to diagnose isolated
pulmonary contusions. With significant chest trauma, however, a CT scan may
be performed to assess for other thoracic injuries and pulmonary contusions
may be coincidentally identified with the exam. Pulmonary contusions on CT
scan appear as areas of air-space consolidation without air bronchograms.
Severe pulmonary contusions on CT scan involving at least one-third of the
lung parenchyma has been shown to correlate with the need for intubation and
mechanical ventilatory support.