Pulmonary parenchymal injuries

Parenchymal infiltrates occurring after trauma may have several causes. Pulmonary contusions and hemorrhages are the direct result of forces to the chest wall or penetration of the lung parenchyma. Aspiration is also common in traumatically injured patients, and may not be distinguishable from pulmonary contusion. Multiply injured patients are also at risk of the development of acute lung injury. It is not uncommon for several of these mechanisms to contribute to the early development of pulmonary dysfunction in trauma patients.

Pulmonary contusions and other parenchymal injuries are almost always treated non-operatively. The mainstay of therapy is supportive pulmonary care, including mechanical ventilation as needed. Rarely, patients with large devitalized segments of pulmonary parenchyma may require thoracotomy for formal operative debridement. However, most patients with this degree of injury will have been operated on early because of hemodynamic instability or ongoing hemorrhage.

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