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PubMed1991

Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases.

Eight patients with an anterior thigh muscle contusion or rupture developed an acute anterior compartment syndrome. All patients had an increased pressure in the quadriceps muscle, ranging between 41 and 80 mm Hg. At fasciotomy, three cases had a hematoma in the rectus femoris and four in the vastus intermedius, and in one case only, edema of the anterior compartment was found. Postoperatively, there was immediate pain relief in all cases, and after about 4 weeks, all patients had normal function. We recommend broad indications for fasciotomy and evacuation of hematoma after thigh muscle contusion or rupture.

Acute Disease↗

PubMed1977

Use of the intra-aortic balloon support for refractory low cardiac output in myocardial contusion.

A patient with refractory low cardiac output and recurring ventricular arrhythmias resulting from myocardial contusion was treated with intra-aortic balloon counterpulsation. Use of the intra-aortic balloon resulted in an increased cardiac output and control of the ventricular arrhythmias. After 1 year the patient shows no sequelae of myocardial contusion, although he is still paraplegic.

Assisted Circulation↗

PubMed1985

The spectrum of myocardial contusion: a review.

Blunt trauma to the chest and abdomen frequently results in cardiac injury. A wide spectrum of pathology can follow, including myocardial concussion and contusion, valvular disruption, and pericardial effusion and tamponade. Likewise, sequelae may be inconsequential or lead to sudden death, and may occur immediately at the time of trauma or be delayed by days to years. Despite the increasingly common occurrence of myocardial contusion there remains much confusion as to how the diagnosis is made. The various diagnostic studies utilized are frequently misinterpreted. The pathophysiology, clinical presentation, and a critical evaluation of the diagnostic tests used in the confirmation of this entity are reviewed, and an approach to the evaluation and management of these patients is presented.

Animals↗

PubMed1986

Determinants of outcome after pulmonary contusion.

During the past 5 1/2 years, 86 patients were treated for pulmonary contusion resulting from blunt trauma. Injury mechanism was motor vehicle in 65 patients (76%), farming in nine (10%), fall in eight (9%), and miscellaneous in four (5%). There were 68 males (79%) and 18 females. Ages ranged from 4 to 75 years (mean, 32 years). Twenty-two patients (26%) presented in hypovolemic shock. Injury Severity Score (ISS) averaged 26 (range, 9-57). Intubation was performed in the Emergency Department in 21 patients (24%), 19 of whom were severely hypoxic with pO2/FIO2 ratio less than 300. Thirty-four patients were ultimately treated with mechanical ventilation for 1 to 103 days (mean, 9.1 days). The average hospital stay was 22 days. Eleven patients (13%) died. Mortality was significantly greater (p less than 0.05) in patients with ISS greater than or equal to 25, initial Glasgow Coma Scale less than or equal to 7, transfusion of greater than three units of blood, and pO2/FIO2 less than 300. Mortality was not correlated with either presence of shock or amount of intravenous fluid administration. Eighteen patients with concomitant flail chest demonstrated no increase in mortality but were likely to require mechanical ventilation (p less than 0.05). The extent of contusion assessed on admission chest roentgenogram was not predictive of mortality or need for intubation. We recommend aggressive treatment of associated injuries, craniocerebral trauma, and selective mechanical ventilation based upon degree of intrapulmonary shunt.

Adolescent↗

PubMed1988

Thromboembolism as a complication of myocardial contusion: a new capricious syndrome.

Myocardial contusion is becoming more frequently recognized as a concomitant of blunt chest and abdominal trauma. Thromboembolism is an infrequent, but serious, complication of myocardial contusion and management is controversial. We report a case and review the literature of thromboembolism complicating blunt heart injury, and suggest a protocol to prevent this complication.

Adolescent↗

PubMed1990

Intra-aortic balloon pump for combined myocardial contusion and thoracic aortic rupture.

The coexistence of myocardial contusion and thoracic aortic injury is probably more common than recognized following rapid deceleration multisystem trauma. This report describes the successful application of intra-aortic balloon counterpulsation in a critically injured patient requiring emergent repair of a thoracic aortic tear complicated by ventricular failure due to cardiac contusion.

Aorta, Thoracic↗

PubMed1992

The clinical significance of myocardial contusion.

In an attempt to identify a group of blunt trauma victims with asymptomatic myocardial contusion (MC) who do not benefit from intensive cardiac monitoring, we prospectively divided 336 patients admitted to the SICU with possible MC following blunt trauma in the 6 years prior to January 1990 into three groups: Group 1 (n = 155, age 30.5 +/- 9 years) consisted of those patients admitted for mechanism of injury, J-point elevation, with or without minor chest injury. None developed arrhythmias. Their SICU length of stay (LOS) was 2.41 +/- 0.77 days. Group 2 (n = 43, age 31.5 +/- 10 years) patients had the same admission criteria as the patients in group 1 plus an abnormal emergency department ECG, i.e., arrhythmia, heart block, ischemia. None had cardiac complications. Their SICU LOS was 2.47 +/- 0.94 days. Group 3 (n = 138, age 40 +/- 20 years) patients had four or more rib fxs, a pulmonary contusion, a flail chest, or extra-thoracic injuries or were greater than 60 years of age. All required SICU admission for their non-cardiac injuries. Nineteen patients had cardiac complications requiring treatment. None had a cardiac death. Their SICU LOS was 10 +/- 22 days. We conclude that young patients with minor blunt thoracic trauma and a normal or minimally abnormal ECG do not benefit from cardiac monitoring.

Adult↗

PubMed1995

Does lung contusion affect both the traumatized and the noninjured lung parenchyma? A morphological and morphometric study in the pig.

Isolated unilateral lung contusion (LC) was induced in 12 pigs to determine the pathophysiological role of LC in the high mortality after multiple injury. The Horovitz quotient, pulmonary vascular resistance, mean pulmonary artery pressure, mixed venous oxygen consumption, inspiratory pressure and compliance were significantly decreased in the LC group as compared to controls. The number of polymorphonuclear granulocytes, the microvascular permeability of albumine and the Wilhelmy balance as determined by bronchoalveolar lavage were significantly increased after lung contusion. As indicators of a systemic reaction we found elevated plasma levels of the terminal complement complex and decreased levels of the complement factor 3a after LC. The morphological assessment revealed changes such as those encountered during the early phase of adult respiratory distress syndrome, with granulocyte sticking, endothelial cell adhesion and transendothelial diapedesis. Morphometric analysis demonstrated a significant decrease in alveolar diameter in both the injured and the contralateral lung due to impaired surfactant surface activity. A distinct increase in septal diameter, related to edema and caused by increased microvascular permeability, was found in the injured lungs. These findings emphasize that LC leads to a generalized impairment of the entire lung, which may lead to progressive lung failure.

Albumins↗

PubMed1996

Experimental pulmonary contusion: review of the literature and description of a new porcine model.

In the setting of pulmonary contusion, massive crystalloid resuscitation of hemorrhagic shock may promote increased lung water leading to stiffer lungs and ultimately culminating in adult respiratory distress syndrome. The emergence of fluids that enable the clinician to resuscitate the bleeding trauma victim by using minimal fluid volumes offers new avenues of investigation for resuscitation of traumatic lung injury. Unfortunately, there has been very little experimental work in the area of pulmonary contusion in the past 15 years. We describe a new porcine model for experimental traumatic lung injury that appears to replicate the clinical scenario.

Animals↗

PubMed1998

Pulmonary contusion in children: diagnosis and management.

BACKGROUND: Pulmonary contusion (PC) is the most common injury identified in pediatric blunt chest trauma. The disagreement over management principles of children with PC may complicate care of these patients. METHODS: We reviewed the literature and our institutional experience. RESULTS: Pulmonary contusion is most often diagnosed by chest roentgenogram, with computed tomography of the chest reserved for more precise evaluation of the mediastinum and aorta. Hypoxemia and respiratory mechanical insufficiency are the most common causes of morbidity from early chest injury. Complications include pneumonia and the adult respiratory distress syndrome, which together may occur in up to one half of all cases. CONCLUSIONS: Early diagnosis, maintaining euvolemia, and selective mechanical ventilation may help to limit morbidity. Management guidelines based on the available literature may improve the care of these patients.

Adolescent↗

PubMed2001

Blunt chest trauma: review of selected pulmonary injuries focusing on pulmonary contusion.

Pulmonary injuries resulting from blunt chest trauma remain a common clinical entity for critical care and emergency nurses. In this article, the epidemiology and mechanism of injury most often observed in patients with blunt chest trauma are reviewed. Selected pulmonary injuries are discussed in terms of mechanism of injuries, assessment and diagnostic modalities, standard therapies, and cutting-edge therapies used today with a focus on pulmonary contusion. Many advances and experimental therapies currently used in the management of the patient with severe lung injuries are discussed. A case study is presented highlighting a complicated case of a blunt chest injury resulting in severe pulmonary contusion.

Contusions↗

PubMed2004

Isolated myocardial contusion in blunt chest trauma.

The objective of this case report was to document a rare case of isolated myocardial contusion in the setting of blunt thoracic trauma. Although demonstrated by electrocardiogram and myocardium-specific enzymes, the trauma had no clinical relevance and the patient was discharged uneventfully from the intensive care unit. The clinical significance of blunt myocardial contusion is then discussed.

Accidents, Occupational↗

PubMed2003

Cardiopulmonary, histological, and inflammatory alterations after lung contusion in a novel mouse model of blunt chest trauma.

Severe blunt chest trauma remains an important injury with high morbidity and mortality. However, the associated immunological alterations are poorly understood. Existing big animal models require large-scale settings, are often too expensive, and research products for immunological studies are limited. In this study we aimed to establish a new model of blunt, isolated and bilateral chest trauma in mice and to characterize its effects on physiological and inflammatory variables. Male C3H/HeN mice (n = 9-10/group) were anesthetized and a femoral artery was catheterized. The animals were subjected to trauma or sham procedure and monitored for 180 min. Blunt chest trauma was induced by a blast wave focused on the thorax. Trauma intensity was optimized by varying the exposure distance. Blood pressure, heart rate, respiratory rate, arterial blood gases and plasma cytokine levels were measured. Macroscopic and microscopic examinations were performed. In addition, outcome was evaluated in a 10-day survival study. Chest trauma caused a drop (P < 0.05) in blood pressure and heart rate, which partly recovered. Blood gases revealed hypoxemia and hypercarbia (P < 0.05) 180 min after trauma. There was marked damage to the lungs but none to abdominal organs. Histologically, the characteristic signs of a bilateral lung contusion with alveolar and intrabronchial hemorrhage were found. Plasma interleukin-6 and tumor necrosis factor alpha were considerably increased after 180 min. Blunt chest trauma resulted in an early mortality of 10% without subsequent death. On the basis of these findings, this novel mouse model of blunt chest trauma appears suitable for detailed studies on immunological effects of lung contusion.

Animals↗

PubMed1988

The identification of different vascular cells on the corneal endothelium by specular microscopy. I. Red blood cells and corneal endothelial changes in hyphaema secondary to contusion injury.

In order to differentiate clearly red blood cells and their relationship to the corneal endothelium, specular microscopy was performed in patients with hyphaema due to contusion injury. This enabled the clear identification of red blood cells as rounded, umbilicated or flattened spheroidal structures depending on whether they were seen side on or end on. They were seen best in the relief mode lying on the posterior endothelial surface and not infiltrating the corneal endothelium. It also disclosed the presence of subendothelial blebs one to three cells in diameter seen at the level of the corneal mosaic and not in the relief mode. These are probably due to mild oedema following the contusion injury and were distinct from the red blood cells. The corneal endothelial cell count and morphology were similar to that in the other eye when the changes resolved a week or so after the injury.

Adolescent↗

PubMed1997

Concrete induced cardiac contusion.

A previously fit 22 year old man was struck in the chest by a concrete block dropped through the windscreen of his car while he was driving on the motorway. He suffered extensive chest wall trauma and lung contusion, which subsequently precipitated acute respiratory distress. On admission ECG showed right bundle branch block and left axis deviation. Three days later QRS duration was normal but there was anterior ST segment elevation and subsequent T wave change. There was a large rise in creatine kinase, and echocardiography revealed septal and apical hyokinesis as well as a mobile mass attached to the left side of the interventricular septum, which had the echogenic texture of myocardium. The patient had fixed perfusion defects in the areas of hypokinesis on thallium scanning but the coronary arteries were unobstructed at angiography. He was treated with warfarin in the short term and an angiotensin converting enzyme inhibitor in the longer term and has made an asymptomatic recovery. Outpatient echocardiography two months after the injury demonstrated some recovery in overall left ventricular systolic function and no evidence of the intracardiac mass. This case illustrates some of the typical features of non-fatal cardiac contusion associated with non-penetrating cardiac trauma, and was complicated by partial thickness avulsion of a strip of the myocardium in the interventricular septum.

Accidents, Traffic↗

PubMed1975

A new method of diagnosing myocardial contusion in man by radionuclide imaging.

A new method of diagnosing myocardial contusion was studied in 8 patients in whom the injured mycardium was visualized as an abnormal area of increased activity in the region of the heart one hour after intravenous injection of 10 mCi of 99m-Tc-Sn-polyphosphate or pyrophosphate. Serum enzymes in these patients were elevated, but electrocardiograms were nonspecific for myocardial injury. It is hoped that this new technique of imaging the injured myocardium will provide specific and confirmatory diagnosis of myocardial contusion associated with closed chest injuries.

Animals↗

PubMed1975

Coronary angiographic and scintigraphic findings in experimental cardiac contusion.

Clinical, angiographic, scintigraphic and pathologic observations in myocardial contusion were correlated. Radionuclide imaging of the injured heart with 99mTc-Sn-polyphosphate provides an accurate diagnosis in acute, even mild, myocardial contusion. The study can be carried out without danger to the critically ill patient. The coronary angiographic findings in this study explain what is occurring pathologically in the heart. Since arteriography is a more invasive technique than radionuclide imaging, its use is recommended only when the image is negative if it is neccessary to establish the clinical diagnosis for treatment or when more than one week has elapsed since the injury.

Acute Disease↗

PubMedDate not supplied

Myocardial contusion culminating in a ruptured pseudoaneurysm of the left ventricle--a case report.

Blunt chest trauma continues to be one of the most common injuries at all ages. Trauma in general is the leading cause of death in the young to middle-aged segment of our population. Blunt chest injury is said to occur in more than one third of all motor vehicle accidents. Myocardial contusion is the most frequent cardiac injury resulting from blunt chest trauma. Autopsy studies indicate that cardiac trauma was directly associated with death in approximately 10% of cases suffering blunt chest injury. Aneurysm formation as a sequela of blunt cardiac trauma is a rare entity and pseudoaneurysm formation is considerably more rare. A case of myocardial contusion resulting in myocardial necrosis, rupture of the ventricle, and pseudoaneurysm formation with subsequent rupture and sudden death is presented.

Accidents, Traffic↗