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PubMed1990

Regional cerebral blood flow after a localized cerebral contusion in pigs.

Regional cerebral blood flow (rCBF) in anaesthetized pigs is investigated before and after an induced focal cerebral contusion. Mean intracranial pressure increased for a short period following the contusion and reduced perfusion pressure to 60% of control pressure. Forty five minutes later the mean intracranial pressure was still high and different from the control values. Global flow and cerebral production of CO2 increased concomitantly. In the cortical region where the contusion was visible macroscopically the rCBF diminished from 36.5 to 29.1 ml/min/100 g. In the rest of the grey matter the rCBF raised after the contusion with an increase away from the centre of the lesion. CBF of cortical grey matter in the region symmetrically to the contusion increased significantly more than in the traumatized hemisphere. White matter rCBF changed least in the region underlying the contusion, while an increase was observed away from the contusion and on the opposite side of the brain. The correlation between tension of CO2 in arterial blood and regional cerebral blood flow disappeared in the region of the contusion. The correlation between global metabolism and regional cerebral blood flow disappeared after the contusion in all regions. Local flow modulating factors influencing flow in the region of macroscopically visible injury has influence abating with distance from the centre of the injury together with a possible neuronally transmitted drive on flow in the opposite hemisphere.

Animals↗
PubMed1997

Synaptic remodeling and free radical formation after brain contusion injury in the rat.

The purpose of this study was to explore whether bilateral frontal cortex contusion in rats would demonstrate changes relevant for understanding the pathology of frontal lobe injury in humans. Rats were allowed to survive for 3, 7, or 18 days postinjury (dpi). In the contused rats, albumin was trapped in frontal cortices, as well as in other brain areas, showing that neurons were exposed to plasma components. In the sham-operated rats, which had only craniotomy but no penetration of dura, the level of trapped albumin was also increased compared to intact controls, suggesting a partial lesion-like condition. Choline acetyltransferase activity was severely decreased in the frontal cortices of contused rats, compared to the sham-operated controls. The decrease was most pronounced at 3 dpi and less pronounced 18 dpi, suggesting that after the initial damage, regeneration of the cholinergic terminals occurred. The concentration of the mature presynaptic membrane protein D3(SNAP-25) was also decreased in the frontal cortices of contused rats at 3 and 7 dpi, whereas it was normalized at 18 dpi. Previously, we have evaluated changes in the rate of synaptic remodeling in brain injury by calculating the ratio of the neural cell adhesion molecule (NCAM) to D3(SNAP-25). The NCAM/D3(SNAP-25) ratio at 3 dpi was elevated by more than 60% in the frontal cortices of contused rats, suggesting a high initial rate of synaptic remodeling. The ratios were smaller at 7 and 18 dpi, suggesting that after the initial burst, the rate of remodeling leveled off. In contrast, astrocyte activation was less pronounced at 3 dpi than at 7 and 18 dpi, as measured by the levels of glial fibrillary acidic protein and glutamine synthetase immunoactivities. The immunoreactivity of glutamine synthetase more than doubled in the contused brains but its enzymatic activity increased less than 50%, suggesting that many enzymatic centers had been inactivated by free radicals. Calculated as the difference between the relative immunoreactivity and the relative enzymatic activity the "lost glutamine synthetase activity" increased continuously in frontal cortex and striatum from 3 to 18 dpi, indicating the production of free radicals long after the initial contusion event. In conclusion, following frontal cortical contusions the early synaptic damage was partly compensated by synaptic remodeling. We suggest that the continuous production of free radicals may have contributed to the declining remodeling rate and impair functional recovery.

Animals↗
PubMed1998

Operative chest wall stabilization in flail chest--outcomes of patients with or without pulmonary contusion.

BACKGROUND: The aim of operative chest wall stabilization in patients with flail chest and respiratory insufficiency is to reduce ventilator time and avoid ventilator associated complications. The purpose of this retrospective study was to analyze the indications and outcomes of operative chest wall stabilization in defined groups of patients sustaining flail chest with and without pulmonary contusion. METHODS: The hospital records of 405 patients with multiple trauma (Injury Severity Score > 17) between 1988 and 1994 were reviewed. Forty-two patients sustained flail chest. Twenty of these underwent operative chest wall stabilization for the following indications: 1) flail chest with indication for thoracotomy due to intrathoracic injury (n = 6); 2) flail chest without pulmonary contusion (n = 9); 3) paradoxical movement of a chest wall segment in the weaning period from the respirator (n = 3); and 4) severe deformity of the chest wall (n = 2). For the purpose of analysis the patients were separated into groups: group 1: operative chest wall stabilization in flail chest without pulmonary contusion (n = 10); group 2: operative chest wall stabilization in flail chest with pulmonary contusion (n = 10); group 3: flail chest without pulmonary contusion and without chest wall stabilization (n = 18); group 4: flail chest with pulmonary contusion and without chest wall stabilization (n = 4). Data were coded for time of operation, duration of ventilatory support, and complications. RESULTS: There were no significant differences in age, severity of injury, and extent of injury between groups 1, 2, and 3 (p < 0.42). Group 4 was excluded for statistical analysis because of the small number of patients. Patients in group 1 required a shorter ventilatory support time compared to patients in group 3 (6.5+/-7.0 versus 26.7+/-29.0 days) and group 2 (p < 0.02). In group 2 (ventilator time 30.8+/-33.7 days) early extubation was only possible in patients being operated on for chest wall instability during weaning from the ventilator. One patient in group 1, three patients in group 2 and five patients in group 3 developed pneumonia with further disturbance of gas exchange. All patients in group 1 survived; deaths in group 2 were attributed to massive hemorrhage in two and septic multiorgan failure in one patient. Four patients in group 3 died of head injury, one of acute respiratory distress syndrome, one of severe hemorrhage, and one of multiple organ failure. CONCLUSIONS: In patients with flail chest and respiratory insufficiency without pulmonary contusion, operative chest wall stabilization permits early extubation. Patients with pulmonary contusion do not benefit from chest wall stabilization. Secondary operative chest wall stabilization in these patients is indicated when progressive collapse of the chest wall is evident during weaning from the ventilator.

Adult↗
PubMedDate not supplied

Comparison of bone contusion seen by MRI in partial and complete tears of the anterior cruciate ligament.

OBJECTIVE: Bone contusions are frequently found in association with complete tears of the anterior cruciate ligament (ACL) and can be a helpful secondary sign in diagnosis. We compare the frequency, location, and significance of bone contusions in complete and partial ACL tears. MATERIALS AND METHODS: Twenty-nine patients with complete and 42 patients with incomplete tears of the ACL were examined by MRI for the presence of accompanying bone contusions within 1 month of injury. RESULTS: Bone contusions were found in 72% of the complete ACL tears but in only 12% of the partial tears. Of the partial ACL tears with accompanying contusions, 80% were high grade injuries that eventually went on to complete rupture within 6 months. Only 16% of the partial ACL injuries without bone contusion progressed to complete rupture at 1-2 year follow-up. There was no difference between the bone contusions of partial and complete tears in terms of general appearance and location. They were predominantly in the lateral compartment (90%) and had a specific predilection for the mid portion of the lateral femoral condyle and the posterior portion of the lateral tibial plateau, often occurring in tandem. CONCLUSION: Bone contusions occur with much less frequency in partial ACL tears than in complete tears but their presence in partial rupture favors a high grade tear that is likely to become complete.

Adolescent↗
PubMed1984

Technetium-fibrinogen lung scanning in canine lung contusion.

To detect experimentally induced acute lung contusion in anesthetized dogs, serial radionuclide images of the lung were recorded following intravenous infusion of 99mTc-labelled human fibrinogen (Tc-HF). The accumulation of Tc-HF in canine lungs was serially quantitated for up to 20 hours after lung contusion. A contusion (#1) was produced in one lung, Tc-HF was injected IV after 15 minutes, and 75 minutes later a contralateral lung contusion (#2) was produced in a series of 14 dogs. At autopsy the excised lungs were scanned, sectioned, and counted for radioactivity. Radiolabelled fibrinogen accumulated within 2-4 minutes of contusion #2 and remained stable over the next 20 hours in 14 dogs; contusion #1 was barely visible in four dogs. Lung Tc-HF activity in the central region of contusion #2 remained sixfold higher than in normal lung tissue. These data suggest that following lung contusion, fibrinogen deposition occurs rapidly and remains stable over a 20-hour interval of observation.

Animals↗
PubMed1998

Contusion of skeletal muscle increases leukocyte-endothelial cell interactions: an intravital-microscopy study in rats.

OBJECTIVE: To investigate the relationship between secondary muscle damage after contusion and the interactions between leukocytes and endothelial cells, which are essential steps in secondary inflammatory response. METHODS: In a randomized animal study, rats were chronically instrumented with dorsal skinfold microvascular chambers and exposed to standardized contusion or sham contusion. Leukocyte rolling and adherence in postcapillary venules before and after muscle contusion or sham contusion were quantitated using in vivo microscopy. RESULTS: The number of rolling leukocytes in the postcapillary venules before contusion was low. At 300 minutes after contusion, the number of rolling and adherent leukocytes in the striated muscle microvasculature was increased significantly (p < or = 0.05) compared with either the baseline precontusion condition or the control group at the same time. CONCLUSION: In the mid-term to long-term stages of skeletal muscle injury associated with contusion, a significant portion of tissue damage is secondary to leukocyte-endothelial cell interactions.

Animals↗
PubMed2000

Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma.

BACKGROUND: The frequency and prognostic influence of myocardial injury in patients with blunt chest trauma is controversial. We investigated the value of cardiac troponin I (cTn-I) and cardiac troponin T (cTn-T), highly specific markers of myocardial injury, to determine whether their measurement would improve the ability to detect myocardial contusion in stable patients with blunt chest trauma in comparison with conventional markers and whether they were associated with significantly worse late clinical outcome. METHODS AND RESULTS: Over an 18-month period, myocardial contusion was diagnosed in 26 of 94 patients (27.6%) with acute blunt chest trauma (motor vehicle crash; 81%), because of echocardiographic abnormalities (n = 12), electrocardiographic abnormalities (n = 29), or both. Patients with myocardial contusion had a significantly higher Injury Severity Score at the time of admission (p = 0.001) and a significantly longer hospital stay (p = 0.0008). All patients survived admission to hospital and were hemodynamically stable. None of the patients died or had severe in-hospital cardiac complications. The percentage of patients with elevated CK, (CK-MB/total CK) ratio, or CK-MB mass concentration was not significantly different between patients with or without myocardial contusion. However, there were significant differences between the two groups when we applied the commonly used threshold levels of CK-MB activity and myoglobin. The percentage of patients with elevated circulating cTn-I and cTn-T (> or = 0.1 microg/L) was significantly higher in patients with myocardial contusion (23% vs. 3%; p = 0.01 and 12% vs. 0%; p = 0.03, respectively). Complete changes in cTn-I and cTn-T correlated well (r = 0.91, p = 0.0001). Sensitivity, specificity, and negative and positive predictive values of cTn-I and cTn-T in predicting a myocardial contusion in blunt trauma patients were 23%, 97%, and 77%, 75%, and 12%, 100%, and 74%, 100%, respectively. Clinical follow-up was available in 83 patients (88%) (mean, 16 +/- 7.5 months). There were no deaths in either group directly attributed to cardiac complications. None of the patients had any long-term cardiac complications or myocardial failure related to blunt chest trauma. CONCLUSION: Although improved specificity of cTn-I and cTn-T compared with conventional markers, it should be emphasized that the main problem with cTn-I and cTn-T is low sensitivity as well as low predictive values in diagnosing myocardial contusion. cTn-I and cTn-T measurement is currently not an improved method in diagnosing blunt cardiac injury in hemodynamically stable patients. Moreover, there was no association of postmyocardial contusion cell injury and late outcome in these patients when cTn-I and cTn-T and other conventional markers were considered.

Abbreviated Injury Scale↗
PubMed1996

Effect of lignocaine in myocardial contusion: an experiment on rabbit isolated heart.

1. The reported incidence of myocardial contusion after blunt chest trauma varies from 16 to 76%. Of these patients, about 6% present a severe, life threatening contusion. We used an isolated heart preparation to examine the effect of lignocaine on myocardial performance after contusion. 2. Thirty hearts obtained from male New Zealand rabbits were perfused at constant flow according to the Langendorff technique and were divided into four groups. The following parameters were measured at frequent intervals for 60 min: mean coronary perfusion pressure (CPP), left ventricular diastolic pressure (LVDP), developed pressure (DP), dP/dtmax, dP/dtmin. 3. Group 1 (n = 6) served as control, group 2 (n = 7) received lignocaine for 20 min (15 microM for the first 10 min and 30 microM for the following 10 min), group 3 (n = 9) had a contusion leading to a 30-50% decrease in dP/dtmax and group 4 (n = 8) had the contusion and the lignocaine infusion was started 10 min after the contusion and stopped after 30 min. Lignocaine concentration was measured in the effluent. 4. Lignocaine alone moderately decreased contractility in group 2. In group 3, after contusion, DP, dP/ dtmax, and dP/dtmin were markedly decreased during the 60 min recording period. In group 4, lignocaine infusion rapidly restored contractility. DP, dP/dtmax and dP/dtmin returned towards their basal values. This improvement of contractility remained stable, even after lignocaine infusion was discontinued. 5. In our rabbit isolated heart preparation, lignocaine at a low therapeutic concentration was able to restore contractility after contusion. These results need to be confirmed by other studies but this may lead to promising therapeutic intervention.

Analysis of Variance↗
PubMed1999

Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging.

PURPOSE: To determine if there are any predictable patterns of internal derangement associated with a bone contusion of the posterior lip of the medial tibial plateau at magnetic resonance (MR) imaging and to offer a biomechanical explanation for the findings. MATERIALS AND METHODS: A retrospective review of 215 consecutive MR examinations for knee trauma was conducted to identify contusions of the posterior lip of the medial tibial plateau. Any additional contusions and internal derangements were documented in the cases with these contusions. Medical charts and arthroscopic results, when available, were reviewed for mechanisms of injury. RESULTS: The specific medial tibial contusion was demonstrated in 25 of 215 (12%) knee MR examinations. Associated anterior cruciate ligament (ACL) tears were found in 25 of the 25 (100%) examinations. Injury to the meniscocapsular junction (14 of 25) or a peripheral tear of the posterior horn of the medial meniscus (10 of 25) occurred in a combined 96% of the cases. Lateral compartment contusions were noted in 24 (96%) cases. Pivot, twisting, or valgus forces were reported mechanisms of injury. CONCLUSION: Contusions involving the posterior lip of the medial tibial plateau may result from a contrecoup impaction injury directly following an ACL tear, as the knee reduces. These contusions are almost always associated with a far peripheral meniscal tear or with a meniscocapsular junction injury affecting the posterior horn of the medial meniscus.

Adolescent↗
PubMed1990

Oedema fluid formation within contused brain tissue as a cause of medically uncontrollable elevation of intracranial pressure: the role of surgical therapy.

In patients with focal cerebral contusions, medical therapies have generally been advocated unless haemorrhages significantly contributing to the elevated intracranial pressure (ICP) exist. We report here several lines of clinical evidence which indicate that (1) enormous amount of extracellular oedema fluid is formed within contused brain tissue, (2) the formation of extracellular oedema fluid within contused brain tissue alone can be a cause of medically uncontrollable elevation of ICP and (3) surgical excision of the contused brain tissue provides excellent control of the elevated ICP in such patients. The excision of contused brain tissue appears to be the only therapy currently available to alleviate the formation of extracellular oedema fluid in cerebral contusions. We believe that, if ICP is elevated primarily by extracellular oedema due to cerebral contusions and the elevated ICP is medically uncontrollable, surgical excision of contused brain tissue should be carried out without delay regardless of the size of associated haemorrhages.

Body Fluids↗
PubMed1994

Bilateral frontal cortical contusion in rats: behavioral and anatomic consequences.

The purpose of this study was to develop a bilateral model of frontal cortical contusion in the rat that would demonstrate reproducible deficits typically found after frontal lobe injury in humans. We used a pneumatically controlled cortical impactor to create bilateral contusions of the medial prefrontal cortex (PFC) in adult male Sprague-Dawley rats. Cognitive, neurologic, physiologic, and histopathologic measures were used to evaluate changes caused by the injury. The cognitive task employed the Morris water maze (MWM). Contused rats performed worse than sham-operated controls on measures of time taken to find a submerged platform, distance to the platform, and swim strategy. Neurologic measures revealed impairments of tongue mobility and transient deficits of forelimb placing. Body weights of the contused rats were chronically reduced with respect to controls, indicating that cortical contusion produces disruption in homeostasis. All rats given bilateral PFC contusions developed marked necrotic cavities at the site of impact. The borders surrounding the cavities were heavily lined with astrocytes and ameboid microglia. There was subcortical gliosis in the medial caudate that extended throughout the rostral-caudal length of the caudate-putamen and into the mediodorsal (MD) and ventrolateral (VL) nuclei of the thalamus. The thalamus was also the site of distal transneuronal degeneration. In both the MD and the VL, there was significant neuronal loss in the contused rats as compared with sham-operated controls. This method of bilateral cortical contusion demonstrates clear, reproducible results that would be required for the development of future pharmacologic therapies designed to promote functional recovery.

Animals↗
PubMed1995

Severe controlled cortical impact in rats: assessment of cerebral edema, blood flow, and contusion volume.

Controlled cortical impact (CCI) is a contemporary model of experimental cerebral contusion. We examined the cerebrovascular and neuropathologic effects of a severe CCI in rats. The utility of magnetic resonance imaging (MRI) for the assessment of contusion volume after severe CCI was also established. Severe CCI (3.0 mm depth, 4 m/sec velocity) to the left (L) parietal cortex was produced in anesthetized (isoflurane/N2O/O2), intubated, and mechanically ventilated male Sprague-Dawley rats (n = 58). Physiologic parameters were controlled. The time course of alterations in edema [L-R% brain water (% BW) in 3-mm coronal sections through injured and contralateral hemispheres, wet-dry weight] was evaluated at 2 h, 24 h, 48 h, and 7 days posttrauma. Local cerebral blood flow (ICBF, measured in 8 structures in each hemisphere by autoradiography) was evaluated at 2 h, 24 h, and 7 days. Contusion volume (measured by histology and image analysis) was assessed at 14 days and measured in 6 rats by both MRI and histology. The survival rate after severe CCI was 96.2%. The L-R difference in % BW increased to 1.69 +/- 0.18% at 2 h, 3.00 +/- 0.08% at 24 h, 2.69 +/- 0.09% at 48 h, and 0.94 +/- 0.21% at 7 days. These values all differed from the control (p < 0.05). The % BW was greater at 24 h and 48 h than at 2 h and 7 days (p < 0.05). Marked reductions in ICBF were limited to structures in the injured hemisphere and were observed in the parietal cortex (2 and 24 h), subcortical white matter (2 and 24 h), and hippocampus (2 h), (p < 0.05) vs control rats. In the contusion core, ICBF was 19.4 +/- 8.8 mL 100 g-1 min-1 at 24 h (p = 0.011 vs normal). Necrosis was seen in large portions of the parietal cortex and subcortical white matter, and portions of the hippocampus and thalamus. Contusion volume was 47.8 +/- 9.2 mm3, which represented 14.4 +/- 2.1% of the traumatized hemisphere. Estimates of contusion volume by MRI and histology were closely correlated (r = 0.941, p < 0.017). Severe CCI in rats is accompanied by contusion, reproducible edema, and marked hypoperfusion, involving over 14% of the injured hemisphere, and can be produced with minimal mortality. T2-weighted MRI successfully and noninvasively identifies contusion volume in this model.

Animals↗
PubMed1989

[Changes in local cerebral glucose utilization, DC potential and extracellular potassium in various degree of experimental cerebral contusion].

UNLABELLED: Pathophysiology of the traumatized brain, especially that of cerebral contusion, is very complex and has not been well understood. In recent years, changes in extracellular ion concentration have been known in various pathological conditions such as cerebral concussion, spinal contusion, ischemia, hypoglycemia, epilepsy and spreading depression as one of the triggers to lead to secondary brain damage. To know the metabolic and ionic changes following cerebral contusion, the authors made various degree of cerebral contusion by fluid percussion method, and observed successive changes in EEG, DC potential, extracellular potassium concentration and local cerebral glucose utilization (LCGU). MATERIALS AND METHODS: Using 42 male Wistar rats, mild (0.2 kg/cm2), moderate (0.4 kg/cm2) and severe contusion (0.6 kg/cm2) were made in the left lower parietal region of the rats. EEG, DC potential and extracellular potassium concentration (using potassium sensitive glass microelectrode) were monitored for four to five hours after making the contusions. LCGU (by 14C-2-deoxyglucose method) was studied at the time of the negative shift of DC potential. RESULTS: The negative shift of DC potential with EEG suppression was observed at 30 min. to 3 hours after injury. The severer the injury was, the earlier and the more frequent negative shifts appeared. LCGU showed no significant changes in the mild injury group. In the moderate injury group, frequent negative shifts of DC potential associated with EEG suppression were observed. A 20% increase of glucose utilization in the cortex of the lesion side was observed whereas 50% decreases in the subcortical structures were found. In the severe injury group, EEG was suppressed immediately after contusion and had never recovered. DC potential fluctuated and was unstable. The increase of LCGU was noted not only in the cortex of the lesion side but also in some of the subcortical structures (hippocampus, caudate nucleus, dentate nucleus and thalamus). The extracellular potassium concentration rose to 30 mM, being correlated closely with DC potential. DISCUSSION: Increase of LCGU associated with EEG suppression, negative shift of DC potential and elevation in extracellular potassium concentration was thought to be due to spreading depression. It was postulated that spreading depression following cerebral contusion causes energy failure and can lead to secondary brain damage.

Animals↗
PubMed1998

Quantitative assessment of respiratory function following contusion injury of the cervical spinal cord.

In this study, we describe a new method for quantitative assessment of phrenic inspiratory motor activity in two models of cervical spinal cord contusion injury. Anesthetized rats received contusion injury either to the descending bulbospinal respiratory pathway on one side of the spinal cord alone (C2 lateralized contusion) or to both the descending pathway, as well as the phrenic motoneuron pool bilaterally (C4/C5 midline contusion). Following injury, respiratory-associated phrenic nerve motor activity was recorded under standardized and then asphyxic conditions. Phrenic nerve efferent activity was rectified, integrated, and quantitated by determining the mean area under the integrated neurograms. The mean integrated area of the four inspiratory bursts recorded just before turning off the ventilator (to induce asphyxia) was determined and divided by the integrated area under the single largest respiratory burst recorded during asphyxia. This latter value was taken as the maximal inspiratory motor response that the rat was capable of generating during respiratory stress. Thus, a percentage of the maximal inspiratory motor drive was established for breathing in control and injured rats under standardized conditions. The results indicate that noninjured rats use 52 +/- 1.8% of maximal inspiratory motor drive under standardized conditions. In C2-contused rats, the results showed that while the percentage of maximal inspiratory motor drive on the noncontused side was similar to the control (55 +/- 4.1%), it was increased on the contused side (78 +/- 2.6%). In C4/5 lesions, the results indicate that this percentage was increased on both sides (77 +/- 4.4%). The results show the feasibility for performing quantitative evaluation of respiratory dysfunction in an animal model of cervical contusion injury. These findings lend to further development of this model for investigations of neuroplasticity and/or therapeutic interventions directed at ameliorating respiratory compromise following cervical spinal cord trauma.

Animals↗
PubMed1990

Cardiac contusion in pediatric patients with blunt thoracic trauma.

To investigate the prevalence of myocardial contusion associated with blunt chest trauma in the pediatric age group, all patients admitted to our institution during a 6-month period with blunt thoracic trauma severe enough to produce a pulmonary contusion or rib fracture were prospectively evaluated. Cardiac evaluation was undertaken, including a multiple-gated acquisition (MUGA) cardiac scan, serial electrocardiograms (ECG), and serum creatine phosphokinase (CPK) and CPK isoenzymes. Seven patients, ranging in age from 2 1/2 to 18 years, with rib fractures or pulmonary contusion by chest roentgenograph were identified. One patient was injured as a passenger in a motor vehicle accident, five were struck by automobiles as pedestrians, and one sustained traumatic asphyxia when a car, supported by a jack, fell on his chest. All had at least one other major organ system injured. All patients had pulmonary contusions as determined by chest radiograph, and two had associated rib fractures. In 43% (three of seven) of patients, a significant cardiac contusion was identified, defined by abnormal right or left ventricular wall motion and a decreased ejection fraction on MUGA scan, and confirmed by an increase in cardiac enzymes and isoenzymes. However, in contrast with adults, no patients had ECG abnormalities. This limited series suggests that cardiac contusion may occur frequently in pediatric patients who have suffered from blunt thoracic trauma significant enough to result in pulmonary contusion. An MUGA scan provides a rapid, noninvasive assessment of cardiac damage in this setting. Further studies will be required to determine the clinical significance and long-term consequences of traumatic myocardial damage in the pediatric population.

Accidents, Traffic↗
PubMed1997

Subpleural sparing: a CT finding of lung contusion in children.

PURPOSE: To evaluate the presence of subpleural sparing as an aid in differentiation of contusion from other causes of lung opacification in children. MATERIALS AND METHODS: In 29 children, the computed tomographic (CT) features of 40 lung contusions were reviewed for the presence of subpleural sparing. Other CT characteristics of lung contusion such as location, shape, and confluence were also evaluated. The presence of subpleural sparing was also evaluated in cases of atelectasis, pulmonary laceration, and a control group of CT scans obtained in 45 patients with bacterial pneumonia and no history of trauma. RESULTS: Subpleural sparing was seen at CT in 38 (95%) of the lung contusions and none of the cases of atelectasis, laceration, or pneumonia (P = .0001). Lung contusions tended to be posterior (60%), crescentic (50%), or amorphous (45%) and have confluent and nodular components (70%). CONCLUSION: The presence of subpleural sparing on CT scans enables accurate identification of lung contusion and differentiation of contusion from other causes of lung opacification in children after trauma.

Case-Control Studies↗
PubMed1979

Pathophysiology of pulmonary contusion in dogs.

We produced a localized right lower lobe (RLL) contusion in 14 anesthetized ventilated dogs, 7 of which were treated with positive end-expiratory pressure (PEEP group). We measured gas exchange, pulmonary mechanics, and regional function before and 5 h after the contusion. Arterial PO2 decreased by 20 Torr and venous admixture doubled in both groups during air breathing. The shunt fraction (Qs/Qt) was minimally increased, despite a large lobar Qs/Qt (0.43) in the contused RLL. These results were explained by reduced ventilation per unit volume (VA/V), and ventilation-to-perfusion ratios of the contused RLL measured with 133Xe technique. We conclude that pulmonary contusion causes a leak of blood and plasma, flooding 25% of the air spaces of the RLL at FRC, reducing the compliance of adjacent air spaces, and resulting in a reduced VA/V and a large RLL Qs/Qt. These results are consistent with the observed reduction in regional volume and perfusion in the contused RLL, and suggest that Qs/Qt was not increased because blood flow was markedly reduced to flooded air spaces. PEEP reduced the hypoxemia, but increased the contusion.

Animals↗
PubMed1996

MR diagnosis of bone contusions of the knee: comparison of coronal T2-weighted fast spin-echo with fat saturation and fast spin-echo STIR images with conventional STIR images.

OBJECTIVES: Bone contusions consist of posttraumatic marrow change resulting from a combination of hemorrhage, edema, and microtrabecular injury and are depicted on MR images as geographic, nonlinear areas of abnormally increased T2 marrow signal intensity. Detection of bone contusions is important, not only in that they are frequently a sign of more serious associated injury, but in that isolated contusions may account for clinical symptoms and thereby obviate further workup. We evaluated two promising rapid imaging sequences, T2-weighted fast spin-echo with fat saturation and fast spin-echo short inversion time (T1) inversion recovery (STIR) and compared their efficacy to that of conventional STIR for the diagnosis of bone contusions in knees. SUBJECTS AND METHODS: Fifty-one consecutive military, retired military, and military-dependent patients were prospectively entered. Imaging consisted of three experimental sequences: coronal T2-weighted fast spin-echo with spectroscopic fat saturation, fast spin-echo STIR, and STIR, as well as conventional T1, proton density, and T2. Each examination was interpreted by three radiologists, for a total of 153 interpretations. Each interpretation consisted of the conventional sequences plus one of the three experimental sequences, blinded to the other two, specifically addressing menisci, ligaments, bones, and soft tissues. A positive test result was defined as a diagnosis of bone contusion on any one of the three independent interpretations of a given examination. Our gold standard was the consensus opinion of all three radiologists in a retrospective, unblinded evaluation of all imaging sequences. Sensitivity and specificity of fast spin-echo with fat saturation and fast spin-echo STIR were then calculated and compared with STIR. RESULTS: Sensitivity and specificity for bone contusion diagnosis in the three experimental sequences were as follows: fast spin-echo with fat saturation, 91% sensitivity and 86% specificity; fast spin-echo STIR, 96% sensitivity and 96% specificity; and conventional STIR, 83% sensitivity and 93% specificity. Our results showed no statistically significant difference between either of the fast spin-echo sequences and conventional STIR (p > .05). CONCLUSION: Because of their comparable accuracy and short imaging time characteristics, coronal fast spin-echo with fat saturation and fast spin-echo STIR sequences are superior to conventional STIR sequences for the diagnosis of bone contusions in knees.

Adolescent↗