What is Pulmonary Contusion in Children

A pulmonary contusion is a deep bruise in the tissues of the lung. The lungs bring oxygen into the bloodstream. A pulmonary contusion causes the lung tissue to swell and bleed into the surrounding area. This may cause your child to have difficulty breathing.

What are the causes?

This condition is usually caused by a chest injury, such as an injury from:

• A severe fall, especially from a great height.
• A car crash.
• A bicycle crash.
• Being near an explosion.
• Sports, especially contact sports.
• Physical assault, especially if the child is struck in the chest with a blunt object.
• A penetrating injury from a sharp object.
• Other accidents, such as a crush injury from industrial or farming machinery.

Children are at higher risk for pulmonary contusions because their ribs are flexible.

What increases the risk?

Your child is more likely to develop this condition if he or she:

• Is not properly secured in a car seat that is right for your child’s age.
• Plays a sport in which contact and falls are common, such as football or soccer.

What are the signs or symptoms?

Common symptoms of this condition include:

• Chest pain, especially when taking a deep breath.
• Spitting up blood.
• Bruising of the chest.

In severe cases, symptoms may get worse over the first 24–48 hours. More serious symptoms include:

• Shortness of breath.
• Coughing.
• Fast breathing.
• Fast heart rate.
• Difficulty breathing.
• Fever.

Some children may not have any symptoms.

How is this diagnosed?

This condition may be diagnosed with:

• Symptoms and physical exam. During the exam, your child’s health care provider may observe his or her breathing, and may check the chest for bruised or swollen areas.
• Imaging tests, such as:
  • Chest X-rays.
  • CT scan.
  • MRI.
• Pulse oximetry. For this test, a sensor is put on the finger to measure heart rate and the amount of oxygen in the bloodstream.
• Arterial blood gases test. This is a blood test that measures the amount of oxygen, carbon dioxide, and acid in the blood.

How is this treated?

This condition may be treated with:

• Pain medicine.
• Deep breathing exercises. These can help to prevent pneumonia.
• Fluids through an IV.
• Oxygen therapy. This may be needed if your child has difficulty breathing and has low blood oxygen. In severe cases, a tube may be placed in your child’s throat and a machine (ventilator) may be used to help with breathing.

Your child may need to stay in the hospital to be watched closely.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin because:
  • It has been associated with Reye syndrome.
  • It may increase bleeding.
• Do not let an older teen drive or use heavy machinery while he or she is taking prescription pain medicine.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Do not let your child lift anything that causes discomfort or pain.
• Keep your child’s chest elevated when he or she is resting or sleeping. Do not let your child lie down flat on his or her back.

General instructions

• Have your child do any deep-breathing exercises as told by his or her health care provider. Your child may use an incentive spirometer to help with this activity if the health care provider recommends it.
• Have your child return to normal activities only as told by his or her health care provider. Talk with the health care provider about:
  • What activities are safe for your child.
  • When your child can return to school, sports, and other activities.
  • When your older teen can return to work, driving, or other activities.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if your child:

• Has a fever.
• Coughs up mucus.
• Has swelling or pain that is not relieved with medicines or treatment.
• Has increased bruising.

Get help right away if your child:

• Has difficulty breathing and it is getting worse.
• Coughs up or vomits blood.
• Feels weak or dizzy, or feels like he or she may faint.

Summary

• A pulmonary contusion is a deep bruise in the tissues of the lung. It causes your child’s lung tissue to swell and bleed.
• This condition is usually caused by a chest injury, such as an injury from a fall or a car crash.
• Treatment for this condition includes pain medicine, deep breathing exercises, and IV fluids. In severe cases, oxygen therapy may be needed.
• Follow instructions from your child’s health care provider about ways to care for your child at home and what activities your child should avoid during recovery.