Bilateral Pulmonary Contusions Research Articles

Post-Traumatic Pulmonary Pneumatoceles: A Case Report

Road accidents are the main cause of serious injuries worldwide, accounting for over 10% of trauma cases resulting in death or significant physical impairment. Thoracic injuries, on the other hand, are responsible for a quarter of all trauma-related deaths. In such cases, pneumothorax is the most common thoracic injury, affecting 30 to 40% of patients with thoracic trauma. This injury occurs twice as often in closed traumas as in penetrating traumas. However, post-traumatic pulmonary pneumatocele is a very rare condition that occurs mostly in children and young adults. It’s often a sequelae of acute pneumonia or barotrauma resulting from alveolar hyperpressure in the context of closed glottis trauma.
 Recognizing these injuries quickly can save lives, whether the patient is outside or in a modern intensive care unit.
 The reported case is an 8-year-old female child with no medical history, no delayed growth or development, who was involved in a public road accident with a thoracic impact. She presented with hemoptysis and chest pain, and a thoracic CT scan revealed bilateral pulmonary parenchymal contusions predominantly on the right, with post-traumatic pneumatoceles on the right side and a right pneumothorax blade, with good progress under surveillance, oxygen therapy, and prophylactic antibiotic treatment.

Effect of amifostine on pulmonary contusion from blunt chest trauma in rats

Purpose: To investigate the efficacy of different doses of amifostine (AMI) and dexamethasone (DXM) on bilateral pulmonary contusion in rats.
 Methods: Forty-two Sprague Dawley rats were divided into six groups of seven animals each (control, pulmonary contusion (PC), PC + AMI 400 mg/kg, PC + AMI 200 mg/kg, PC + AMI 400 mg/kg + DXM, and PC + DXM-treated groups). RelAssay commercial kit was used to determine total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). Nitric oxide (NO), inducible nitric oxide synthase (iNOS), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) activity associated with blunt trauma induced pulmonary damage were determined by enzyme-linked immunosorbent assay (ELISA). Blood gas was determined using a blood gas analyzer, while histopathological examinations were performed on the tissues by hematoxylin and eosin (H & E) staining method.
 Results: Significant improvement in biochemical parameters and histopathological findings were observed in the groups treated with dexamethasone and high-dose amifostine (400 mg/kg; p < 0.05). However, low-dose amifostine (200 mg/kg) and a combination of dexamethasone with amifostine (400 g/kg) was ineffective in balancing the biochemical changes due to trauma (p > 0.05).
 Conclusion: High-dose amifostine combined with dexamethasone mitigates trauma-induced damage in rat by preventing the elevation of key inflammatory markers. Further preclinical and clinical studies are required to determine the efficacy of amifostine in humans and to compare its activity with other agents.

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.

Bilateral thoracic trauma-"double the trouble"?

Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma. The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two. In aretrospective study, data from all patients diagnosed with thoracic trauma at alevelI trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome. A total of 714patients were included in the analysis. The mean Injury Severity Score (ISS) was19. Patients with an additional thoracic spine injury had asignificantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for achest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors. Patients with bilateral chest trauma had an increased incidence of complications and ahigher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.

1036 Traumatic Complications of Unrecognized Somnambulance in a Pediatric Patient

Abstract Introduction Parasomnias are unusual, disruptive, and abnormal verbal or motor events that occur during sleep or between wake and sleep transitions. They can occur in non-rapid eye movement (NREM) or rapid eye movement (REM) sleep stages. NREM parasomnias are typically more prevalent in pediatric populations. One such NREM parasomnia is sleep walking or somnambulance. One study estimates somnambulance has a prevalence of 17% in ages 3-13 years¹. Somnambulance typically occurs during stage 3 sleep which is clustered in the first half of sleep when REM is less prevalent Report of case(s) A 4-year-old previously healthy male presented to clinic for a somnambulance consult. Around 6 months prior, his parents awoke around 3 AM to check on their crying infant, a sibling of our patient, and noticed the patient was missing. They noticed the back door open. Two blocks away they saw police lights and found he had been hit by a vehicle. He was admitted to the hospital for polytrauma, including bilateral pulmonary contusions with acute respiratory failure, grade 4 liver and kidney lacerations, grade 3 adrenal injury, and right parietal lobe parenchymal and subarachnoid hemorrhages. He was later discharged in stable condition with persistent but improved spasticity, impaired mobility, and cognition. His parents had not noticed any prior episodes of somnambulance. However, they did report other frequent parasomnias: somniloquy and confusional arousals. These episodes were worse following late evenings. There was a strong family history of somnambulance in the parent’s siblings. They denied any sleep disordered breathing symptoms. Parents were reassured and educated about parasomnia's self-limited nature but to keep a safe environment and avoid sleep deprivation. Conclusion The majority of parasomnia in children have benign outcomes and eventual self-resolution with age. However, rare circumstances arise where these events can be hazardous including sleep-cooking, risking fire and burns or, as in this case, unknowingly walking into traffic. A sleep study is not always needed as parasomnias are a clinical diagnosis. However, it’s important to note that if a patient has a history of parasomnias parents should be educated on the importance of keeping a safe environment to prevent possible harm. Support (if any)

332 Role of Kynurenine/Tryptophan Ratio in Kidney-Lung crosstalk in two porcine trauma-induced multi-organ injury models

OBJECTIVES/GOALS: Multiple Organ Failure, often precipitated by Acute Lung Injury, is a life-threatening condition that causes death in military and civilian life. Furthermore, Acute Kidney Injury is very common, increasing morbidity and mortality rates. Therefore, understanding the molecular difference between survivors and non-survivors is urgently needed. METHODS/STUDY POPULATION: A 24-hour unilateral pulmonary contusion porcine model (pneumonectomy) of trauma-induced Multiple Organ Failure (MOF) model (n=17) and separate 48-hour polytrauma injury of bilateral pulmonary contusion, traumatic brain injury, and hemorrhage (polytrauma) MOF model (n=26) was developed at Dr. Batchinsky's AREVA laboratory. Serum was assayed at baseline and 3h or 6h post-trauma for amino acid metabolites using the Zip-Chip platform for mass spectrometry. The IDO1 enzyme activity assay kit (ab235936) was used to measure IDO1 enzyme activity in the tissue. Mass Spectrometry Imaging (MSI) was employed to frozen kidney tissues. Tissues were sectioned to 10- micron thickness. For MSI, the DAN matrix was utilized, and MALDI-MSI images were processed and obtained from METASPACE and SCILS software. RESULTS/ANTICIPATED RESULTS: In the pneumonectomy model, 10 survived, 7 died, and in the polytrauma group, 13 survived, and 13 died. In the pneumonectomy model, there was a significant increase in the serum kynurenine/tryptophan (KYN/TRP) ratio in the non-survivors 3h post-injury. A similar pattern was found in the validation group, which showed a significant increase in the KYN/TRP ratio at 6h post-trauma in non-survivors from the polytrauma model. There was a significant increase in IDO1 enzyme activity in non-survivor kidney tissues and a downregulation of tryptophan (TRP) metabolite in the kidney section in the non-survivor group post-trauma. DISCUSSION/SIGNIFICANCE: An increase in the KYN/TRP ratio post-trauma identified the pigs that suffered early mortality. A decrease in TRP metabolite and an increase in IDO1 enzyme activity in the kidney could contribute to an increase in KYN in the non-survivors. As a result, focusing on therapeutics targeting the KYN/TRP to reduce the incidence and severity of MOF is warranted.

Post-traumatic acute aortic regurgitation due to cusp rupture in non-calcific bicuspid valve treated with ballon-expandable transcatheter heart valve.

A 65-year-old male truck driver was admitted to the emergency department after a road crush with consequent polytrauma. Patient’s past medical and cardiovascular history were unremarkable. Physical examination showed neck haematoma with multiple contusions, abolished right vesicular murmur, bone deformities. Whole-body CT scan documented multiple bone fractures, right hemothorax and pneumothorax, mediastinal haematoma, bilateral pulmonary contusions and rib fractures, dissection not limiting flow of right subclavian artery, left vertebral artery and both internal carotid arteries with associated pseudoaneurysms. Emergency chest drainage was performed and the patient was intubated because of worsening dyspnoea. Transthoracic echocardiography documented massive aortic insufficiency due to cusp rupture (Panels A and B and Supplementary material online, Videos S1 and S2) in the context of aortic bicuspidia (Sievers Type 1) and pulmonary hypertension with signs of right ventricular dysfunction. Because of patient’s extremely critical condition with hemodynamic instability and pulmonary congestion and concomitant prohibitive surgical risk for urgent aortic valve replacement, off-label transcatheter aortic valve replacement was planned.

Expeditionary Mechanical Ventilation in Conjunction With Extracorporeal Life Support During Ground Transport.

We assessed the use of an FDA-cleared transport ventilator with limited functions and settings during ground transport in a swine model of ground evacuation. We hypothesized that when used as an adjunct to extracorporeal life support (ECLS), the device would enable safe mobile ventilatory support during ground evacuation. Female Yorkshire swine (n = 11; mean, 52.4 ± 1.3 kg) were sedated and anesthetized and received mechanical ventilation (MV) with a standard intensive care unit (ICU) ventilator and were transitioned to the Simplified Automated Ventilator II (SAVe II; AutoMedx) during ground transport. MV served as an adjunct to ECLS in all animals. Ventilator performance was assessed in the uninjured state on day 1 and after bilateral pulmonary contusion on day 2. Data were collected pre- and post-transport on both days. During 33 transports, the SAVe II provided similar ventilation support as the ICU ventilator. Mean total transport time was 38.8 ± 2.1 minutes. The peak inspiratory pressure (PIP) limit was the only variable to show consistent differences pre- and post-transport and between ventilators. No adverse events occurred. As an adjunctive supportive device during ground transport, the SAVe II performed adequately without failure or degradation in subject status. Further testing is warranted to elucidate the clinical limits of this device during standalone use.

Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion. MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality. ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications. ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.

Expression of High Mobility Group Box 1 Protein in a Polytrauma Model During Ground Transport and Simulated High-Altitude Evacuation.

We investigated the expression of high mobility group box 1 (HMGB1) protein in a combat-relevant polytrauma/ acute respiratory distress syndrome (ARDS) model. We hypothesized that systemic HMGB1 expression is increased after injury and during aeromedical evacuation (AE) at altitude. Female Yorkshire swine (n =15) were anesthetized and cannulated with a 23Fr dual-lumen catheter. Venovenous extracorporeal life support (VV ECLS) was initiated via the right jugular vein and carried out with animals uninjured on day 1 and injured by bilateral pulmonary contusion on day 2. On both days, animals underwent transport and simulated AE. Systemic HMGB1 expression was measured in plasma by ELISA. Plasma-free Hb (pfHb) was measured with the use of spectrophotometric methods. Plasma HMGB1 on day 1 was transiently higher at arrival to the AE chambers, increased significantly after injury, reaching highest values at 8,000 ft on day 2, after which levels decreased but remained elevated versus baseline at each time point. pfHb decreased on day 1 at 30,000 ft and significantly increased on day 2 at 8,000 ft and postflight. Systemic HMGB1 demonstrated sustained elevation after trauma and altitude transport and may provide a useful monitoring capability during en route care.

Radiation diagnostics of thoracic gunshot wounds

The frequency of thoracic injuries in the general structure of combat surgical trauma remains at the level of 7-12 % and unchanged from the time of the Second World War to the current armed conflicts. The overwhelming majority of them (up to 72 %) are shrapnel gunshot wounds. The formation of a gunshot wound occurs due to the action of a shock wave; a wounding projectile; energy of side impact and vortex wake. The shape, size, features of the wound canal are determined by the kinetic energy of the wounding agent and the physical properties of the damaged tissues. The lung parenchyma is loose and elastic, so small-caliber bullets with low energy cause minimal damage. The wound canal is well differentiated on CT-slices. Its cavity is filled with blood, fragments of destroyed tissue, air bubbles. On the periphery, the contusion zone is determined (area of increased attenuation in the lung-ground-glass opacity). Shrapnel wounds can be accompanied by ruptures of the pulmonary parenchyma with hemorrhages, bilateral pulmonary contusion, damage to the bone frame and soft tissues of the chest. Vascular injury with massive hemorrhage into the pleural cavity and tense hemopneumothorax are one of the main causes of mortality in penetrating wounds. Transmediastinal gunshot wounds, armor trauma and bullet embolism require special attention during radiation examination of victims. The purpose of radiation diagnostics of modern combat trauma is to identify and fully characterize injuries and their complications. The amount of diagnostic information is determined by the level of medical care. Key words: gunshot wounds, chest cavity organs, radiation diagnostics.

An Unusual and Fatal Case of Perthes’ Syndrome

Perthes syndrome includes cervical and facial cyanosis, subconjunctival haemorrhage, petechial haemorrhages on the face, neck, and upper chest, secondary to chest compression. We report a clinical case of Perthes’ syndrome in 3-year-old boy victims of chest crush by a tractor. Clinical examination found: a Glasgow score at 13/15, polypnea, tachycardia, hypotension; wound of the occipital scalp, a low abundance of hematuria, deformation of the left lower limb. Body scan: bilateral pneumothorax and pulmonary contusions, left hemothorax; lacerations at the medial and upper renal pole grade IV, a low abundance of retroperitoneal hematoma, fracture of the left femur. Biological assessment showed major metabolic disturbances with severe acute rhabdomyolysis and multi-visceral failure. Without clinical improvement, the patient died after 36 hours of intensive care.

Investigation of the Efficacy of Aminoguanidine in an Experimental Rat Model with Isolated Bilateral Pulmonary Contusion Due To Blunt Thoracic Trauma

Investigation of the Efficacy of Aminoguanidine in an Experimental Rat Model with Isolated Bilateral Pulmonary Contusion Due To Blunt Thoracic Trauma

Hybrid open and endovascular repair of a blunt traumatic thoracic aortic injury in a 7 year old boy

We describe a 7-year-old boy who sustained a blunt thoracic aortic injury following a rollover motor vehicle crash where the vehicle fell 200 feet down an embankment. The chest x-ray on arrival showed widening of the superior mediastinum, a left-sided hemothorax, and first rib fracture. The screening CTA of the chest revealed bilateral pulmonary contusions, a large left hemothorax, and evidence of aortic injury with active contrast extravasation. The patient was intubated due to respiratory distress and had a left chest tube placed. The patient became hypotensive with greater than 1.5 L of blood from the chest tube, so a resuscitative thoracotomy was performed. Bleeding was controlled with a sponge stick initially and definitively with a Satinsky vascular clamp. Next the patient was transported to the hybrid OR at the adjacent adult hospital with an open chest for endovascular graft placement. The patient was admitted to the PICU post-operatively, transferred to the floor on POD 4, and discharged home on POD 9. Aortic injury after blunt trauma in pre-adolescent children is uncommon and often fatal. Endovascular repair of traumatic thoracic aortic injury in adults is currently the standard of care, but there is a paucity of clinical data to guide management of these types of injuries in pediatric patients.

Complications from Pulmonary Contusions after Rib Plating: A Case Series and Lessons Learned

Background: Surgical stabilization of rib fractures (SSRF) is increasing in popularity with low reported complication rates. Pulmonary contusion (PC) has been cited as a relative contraindication to SSRF in cases of patients with respiratory failure due to chest wall injury. However, the reported experience and clinical data regarding PC on this topic remain limited. The objective of this study was to describe the experience treating patients with moderate-to-severe PCs utilizing SSRF and identify risk factors for pulmonary complications postoperative acute respiratory distress syndrome (ARDS). Methods: The trauma registry of a Level 1 trauma center was reviewed from 2015 to 2019, and patients who underwent SSRF were assessed. Computed tomography was examined, and PC score was calculated in patients with a documented PC by a researcher and verified by a board-certified radiologist using the PC score as described by Chen et al. Demographic, clinical, and outcome data were analyzed and reported. Results: Ninety-two patients were included in the initial analysis as having undergone SSRF in the study period. The patients were 72.8% male and averaged 5.5 ± 4.4 days from admission to SSRF. Nine patients with severe chest trauma and PCs underwent SSRF. Of these patients, four had severe bilateral PCs and five had severe unilateral PC, totaling >20% of total lung capacity. Three patients had ipsilateral moderate-to-severe PCs with traumatic pneumatoceles. They underwent SSRF within 48 h of admission per standard practice. They were all placed in the lateral decubitus position with the affected side up. Their intraoperative courses were complicated by bloody secretions present in the endotracheal tubes. Only one patient had lung isolation using dual-lumen endotracheal intubation and had an uneventful perioperative course. Postoperatively, the other two patients developed severe ARDS that required mechanical ventilation for several days, significantly complicating their recovery. Discussion: This case series highlights the relative risk of SSRF in patients with significant PC. Early SSRF in patients with PC ≥3 was associated with ARDS when patients did not undergo intraoperative lung isolation. In two patients with severe PC, the contusions themselves did not produce respiratory failure on admission; however, intraoperative positioning resulted in the aspiration of bloody secretions from the contused lung into the unaffected lung, causing severe postoperative ARDS. Suggested measures to prevent future events may include isolating the contused lung intraoperatively or delaying SSRF until contusion has resolved, if feasible.

Post Traumatic Multi-Injured patients. To wait, to operate or to use Damage Control Orthopedic template? A case report

Abstract Purpose. Damage Control Orthopedics (DCO) is a surgical concept used in the recovery of seriously injured patients. Given that the leading cause of death among trauma patients remains uncontrolled hemorrhage, DCO emphasizes on preventing the "lethal triad” of acidosis, coagulopathy and hypothermia, rather than correcting the anatomy immediately. Thereby, we are presenting the crucial importance of using this technique in severe trauma cases. Methods. A 23-year-old female was admitted in the Emergency Room as a multi-trauma patient. Following the Advanced Trauma Life Support protocol, fully exposure examination showed bilateral forearm and femur deformities, with bilateral open femur fracture, left ankle deformity and pelvic ecchymosis. X-rays confirmed fractures of the ribs, bilateral pulmonary contusion, fracture of the left ankle fracture, bilateral superior and inferior pubic ramus, and bilateral femur fractures with both bone midshaft fracture on the right leg. DCO was proceeded immediately, during which external fixators were placed on the fractures, while splinting both forearms. After 11 days in the Intensive Care Unit (ICU), the patient underwent the definitive surgeries. Results. Managing the patient with the DCO protocol first and not rushing with the definitive surgical procedures resulted in a proper stabilization. After two years follow up, the patient fully recovered and returned to a normal life style. Conclusion. Performing a definitive operation on severely injured patients results in deleterious effects that could lower life expectancy. Short-term physiological recovery should be prioritized over definitive management and DCO should be proceeded in order for the best outcomes to be achieved.

Heparin-free extracorporeal membrane oxygenation in a patient with severe pulmonary contusions and bronchial disruption.

Pulmonary contusion complicated with endobronchial hemorrhage is potentially life-threatening, particularly in patients with tracheobronchial tree disruption and severe airway bleeding after blunt trauma, and pose a high mortality risk. In such cases, extracorporeal membrane oxygenation (ECMO) can be used as a salvage treatment modality. However, the use of ECMO for moribund trauma patients with respiratory failure may be limited for several reasons, such as intractable bleeding. In this case report, we describe a patient with severe bilateral pulmonary contusions with tracheobronchial tree disruption that was successfully treated using heparin-free venovenous ECMO.

Extracorporeal membrane oxygenation support for a multitrauma patient with ARDS: A case report and literature review.

Extracorporeal membrane oxygenation (ECMO) provides rescue treatment for patients with severe acute respiratory distress syndrome (ARDS) when conventional management fails. The present study reported ECMO as a life-saving treatment for ARDS due to bilateral pulmonary contusion in a 24-year-old male multiple trauma patient. ECMO therapy lasted 7 days for the patient and was successively stopped without any complications. ECMO modality should be chosen according to the respiratory and circulatory condition of each individual. Venoarteria-ECMO may be chosen for multiple trauma patients with ARDS, and respiratory and circulatory failure. Morphological changes are observed with ARDS progression. The injured lungs may recover completely with effective ECMO therapy.

Clinical Significance and Prognostic Implications of Quantifying Pulmonary Contusion Volume in Patients with Blunt Chest Trauma

BackgroundPulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to investigate the clinical correlation between PC volume and outcome in patients with blunt chest trauma (BCT).Material/MethodsBCT patients with PC were identified retrospectively from the prospectively collected trauma registry database over a 2-year period. Contusion volume was measured and expressed as percentage of total lung (CTCV) volume using three-dimensional reconstruction of thoracic CT images on admission. Data included patients’ demographics, mechanism of injury (MOI) and injury severity, associated injuries, CTCV, mechanical ventilation, complications, and mortality.ResultsA total of 226 BCT patients were identified to have PC with a mean age of 35.2 years. Motor vehicle crash (54.4%) and falls (16.4%) were the most frequent MOIs. Bilateral PC (61.5%) was more prevalent than right-sided (19.5%) and left-sided PC (19%). CTCV had a significant positive correlation with ISS; whereas, age and PaO2/FiO2 ratio showed a negative correlation (p<0.05 for all). The median CTCV was significantly higher in patients who developed in-hospital complications (p=0.02). A CTCV >20% was associated with increasedrisk of acute respiratory distress syndrome (ARDS), blood transfusion and prolonged mechanical ventilation. However, multiple linear regression analysis showed that CTCV alone was not an independent predictor of in-hospital outcomes. Presence of chest infection, CTCV, and Injury Severity Scores were predictors of ARDS.ConclusionsQuantifying pulmonary contusion volume could allow identification of patients at high-risk of ARDS. CTCV has a significant correlation with injury severity in patients with BCT. Further prospective studies are needed to address the validity of CTCV in the patients care.

Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma

A 25-year-old Hispanic male was transferred to our level I trauma center after being ejected 40 feet from a motor vehicle crash. Once stabilized in the trauma bay, a computed tomography (CT) scan of the abdomen/pelvis with IV contrast revealed two AAST Organ Injury Scale grade III liver lacerations without contrast extravasation, bilateral pulmonary contusions, right posterior non-displaced fourth rib fracture, non-displaced right scapular body fracture, and bilateral anterior and posterior pelvic fractures [Figures 1–2]. A non-operative approach to the hepatic lacerations was chosen and the patient underwent closed reduction and percutaneous pinning of his posterior pelvic fractures as well as anterior external fixation of his bilateral pubic rami fractures.