Post-traumatic pulmonary contusion in children

We reviewed 35 consecutive cases of post-traumatic pulmonary contusion in children that occurred during a 12-year period. Of these, 19 children (54%) were more than 5 years old, 30 (86%) were involved in motor vehicle accidents, and 29 (83%) had multiple trauma. External thoracic wall contusion, fracture of the bony thorax, tachypnea, hemoptysis, and abnormal breath sounds were frequently absent on presentation. Associated intrathoracic lesions of pleural effusion, pneumothorax, and hemothorax occurred in 20 children (57%) and were particularly prevalent in those with fracture of the bony thorax (93%); the radiographic appearance of these lesions was delayed up to 48 hours in 40% of cases. In 34 children (97%), radiographic evidence of pulmonary contusion was present on admission and did not progress radiographically during hospitalization. No child experienced respiratory deterioration subsequent to presentation or required mechanical ventilation for respiratory insufficiency. Pulmonary contusion in children is usually a consequence of significant-impact injury associated with multiple trauma and has a good prognosis. Despite a paucity of abnormal physical findings, children who sustain high-impact trauma should receive radiographic evaluation of the chest to assess for possible intrathoracic injury. When pulmonary contusion is accompanied by fracture of the bony thorax, serial radiographic evaluation of the chest should be performed during the initial 48 hours of hospitalization.