Pulmonary contusion: clinical reasoning

According to statistics, chest injuries rank third in prevalence and are characterized by high mortality, which is 35 – 45%. This article presents a patient diagnosed and treated for bilateral pulmonary contusion with post-traumatic pneumonitis after a combined mine-explosive injury.

Purpose. Of particular interest to the clinician is the understanding of lung injury from the standpoint of interpretation of diagnosis, methods of diagnosis, and differential diagnosis with pneumonia, prevention of complications, and rational treatment tactics. The terms “pneumonitis” and “pneumonia” are not synonymous. In modern terminology, it is customary to use the term pneumonitis for a pathologic process in the alveoli without an infectious process in the vast majority of cases, and infectious forms of pulmonary inflammation are referred to as pneumonia. In this clinical case (and in similar situations), it is advisable to take into account the pathogenesis of changes in lung tissue after pulmonary contusion, leading to post-traumatic pneumonitis, which often requires additional specific therapy and rehabilitation for rapid recovery of lung function. Proper tactics in prescribing anti-inflammatory and antibacterial drugs are critical, as is treatment aimed at preventing complications, including prevention of fibrous changes in the lung.

Conclusion. Given the relevance of this topic, it is currently advisable to introduce monitoring of CRP and procalcitonin levels, coagulogram, and gas composition of arterial blood, if necessary, in the patient management. It is advisable to use computed tomography to clarify the nature of the changes. The problem of follow-up and rehabilitation of patients with chest injuries and pulmonary contusion is relevant.

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