Imaging findings of pulmonary contusions on multidetector CT: A retrospective study comparing adults and children

Abstract

To describe imaging findings of pulmonary contusions (PC) in adults and children using multidetector computed tomography (CT) scanners. We conducted a retrospective single center study. All chest multidetector computed tomography (MDCT) scans of victims of blunt trauma admitted to the emergency unit of a reference trauma center of Brazil between January 2015 and December 2016 were reviewed in search of opacities compatible with PC. The CT images were analyzed in conjunction with medical records, that provided demographic and clinical data. The obtained data were analyzed in the overall population and comparing children and adults. Significant P value was defined as <.05. 52.7% of patients presented bilateral opacities. Middle third, posterior and peripheral portions of the lungs were more frequently affected, in the craniocaudal, anteroposterior and axial axes, respectively. A vast majority of patients (80.6%) presented multiple opacities, whereas a minority showed subpleural sparing (26.9%) and fissure crossing (22.6%), with similar frequencies in children and adults. Children, although, more frequently presented consolidation and more diffuse lesions in the anteroposterior axis compared to adults, with statistically significant differences. PC usually are multiple and predominate in middle, posterior and peripheral portions of the lungs. Subpleural sparing and fissure crossing seems to be infrequent and have similar frequencies between children and adults. Although, there are differences between these age groups, as younger people tend to have more consolidation and diffuse opacities in the anteroposterior axis than older ones.

Figure 1.

Crescentic GGO in the subpleural posterior portion of the inferior right lung of a 26 years old man victim of a motorcycle accident. This type of opacity is possibly associated to reflection of forces by the chest wall (“mirror effect”). GGO = ground-glass opacities.

Figure 2.

Subpleural sparing (arrows) in 3 different patients: (A) 20 years old woman victim of car crash; (B) 13 years old male children victim of auto-pedestrian accident; and (C) 27 years old woman victim of run auto-pedestrian accident. There are motion artifacts in (B).

Figure 3.

Fissure crossing in a 27 years old man victim of motorcycle accident. (a) Axial and (b) sagittal planes. The arrows show the oblique fissure.