Skip to main content
SpringerLink
Log in
Book cover

Tscherne Unfallchirurgie pp 251–272Cite as

Lungenkontusion

  • Chapter

Zusammenfassung

Eine Lungenkontusion wurde vermutlich erstmals in einer Mitteilung von Morgagni (1761) beschrieben. Der Autor berichtet über eine „Lungenverletzung bei unverletztem Brustkorb“. Weitere Fallbeschreibungen finden sich ab der Mitte des letzten Jahrhunderts. Die erste umfassende Definition wird von Payne 1909 [54] formuliert:

„Es existiert ein eigenständiges Krankheitsbild im Sinne einer Kontusion der Lunge. Die Lunge kann kontusioniert werden, ohne eingerissen zu sein. Beide Verletzungen konnen auch bei unauffälliger Thoraxkonfiguration und -weichteilen vorhanden sein. Die Kontusion der Lunge kann sich zu einer gefährlichen Form der Pneumonie entwickeln.“

Obgleich im selben Zeitraum auch ein Zusammenhang zwischen Verletzungsrichtung und Ausmaß des Schadens beschrieben wurde, blieben doch zunächst die Kenntnisse um die Pathophysiologie rudimentär. Zwar wurde schon ein kausaler Zusammenhang zwischen der Verletzung und dem Lungenversagen erkannt, jedoch wurde die sich entwickelnde pulmonale Insuffizienz als „Pneumonie“ fehlgedeutet. Ebenso waren die therapeutischen Bemühungen ohne Erfolg.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Allen GS, Coates NE (1996) Pulmonary contusion: A collective review. Am Surg 62 (11): 895–900

    PubMed  CAS  Google Scholar 

  2. Bartlett RH, Morris AH, Farley HB (1986) A prospective study of acute hypoxic respiratory failure. Chest 89: 684–688

    Article  PubMed  CAS  Google Scholar 

  3. Becker DM, Gonzalez M, Gentili A, Eismont F, Green BA (1987) Prevention of deep venous thrombosis in patients with acute spinal cord injuries: use of rotating treatment tables. Neurosurgery 20: 675–677

    Article  PubMed  CAS  Google Scholar 

  4. Bernard GR, Brigham KL (1986) Pulmonary edema. Pathophysiologic mechanisms and new approaches to therapy. Chest 89: 594–600

    Article  PubMed  CAS  Google Scholar 

  5. Borg U, Stoklosa JC, Siegel JH (1989) Prospective evaluation of combined high frequency ventilation in post-traumatic patients with adult respiratory distress syndrome refractory to conventional ventilatory management. Crit Care Med 17: 1129–1142

    Article  PubMed  CAS  Google Scholar 

  6. Ciraulo DL, Eliott D, Mitchell KA, Rodriguez A (1994) Flail chest as a marker of significant injuries. J Am Coll Surg 178 (5): 466–470

    PubMed  CAS  Google Scholar 

  7. Clark GC, Schecter WP, Trunkey DD (1988) Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 28: 298–304

    Article  PubMed  CAS  Google Scholar 

  8. Cohn SM, Zieg PM (1996) Experimental pulmonary contusion: review of the literature and description of a new porcine model. J Trauma 41 (3): 565–571

    Article  PubMed  CAS  Google Scholar 

  9. Craven KD, Oppenheimer L, Wood LD (1979) Effects of lung contusion and flail chest on pulmonary perfusion and gas exchange. J Appl Physiol 47: 729–737

    PubMed  CAS  Google Scholar 

  10. Danz B, Biehl C, Bähren W (1996) Zur Akutdiagnostik therapierelevanter Thoraxverletzungen bei schwer-und polytraumatisierten Patienten. Fortschr Rontgenstr 164 (4): 269–274

    Article  CAS  Google Scholar 

  11. Dantzker DR, Brook CJ, Dehart P, Lynch JP, Weg JG (1979) Ventilation-perfusion distributions in the adult respiratory distress syndrome. Am Rev Resp Dis 120: 1039–1052

    PubMed  CAS  Google Scholar 

  12. Demling RH, Proctor R, Grossman J (1987) Lung injury and lysosomal enzyme release during endodotxemia. J Surg Res 30: 135–141

    Article  Google Scholar 

  13. Dinkel E, Uhl H, Reinbold WD, Wimmer B, Wenz W (1987) Computertomographie beim Thoraxtrauma. Radiologie 27: 391–397

    CAS  Google Scholar 

  14. Dresing K, Sievers KW, Obertacke U, Reicke B, Schmit-Neuerburg K-P (1994) Primär-und Verlaufsdiagnostik nach Thoraxtrauma und Lungenkontusion. Zentralblatt Chir 119: 690–701

    CAS  Google Scholar 

  15. Färber D, Hahn H, Fendt-Klug T, Hopner F (1995) Thoraxtrauma im Kindesalter. Radiologe 35: 385–390

    PubMed  Google Scholar 

  16. Finfer S, Rocker G (1996) Alveolar overdistension is an important mechanism of persitent lung damage following severe protrated ARDS. Anaesth Intensive Care 24: 569–573

    PubMed  CAS  Google Scholar 

  17. Fishman AP (1961) Respiratory gases in the regulation of the pulmonary circulation. Physiol Rev 41: 214–280

    PubMed  CAS  Google Scholar 

  18. Fulton RL, Peter ET (1970) Theprogressive nature of pulmonary contusion. Surgery 67 (3): 499–506

    PubMed  CAS  Google Scholar 

  19. Gahr RH, Hasse FM, Nurnberger HR (1990) Die Wertigkeit der Thorax-Computertomographie in der Intensivdiagnostik des stumpfen Thoraxtraumas. Z Unfallchir Versicherungsmed 83 (2): 111–116

    PubMed  CAS  Google Scholar 

  20. Gaillard M, Herve C, Mandin L, Raynaud P (1990) Mortality prognostic factors in chest injury. J Trauma 30: 93–96

    Article  PubMed  CAS  Google Scholar 

  21. Gattinoni L, Pelosi P, Vitale G, Pesenti A, D’Andrea L, Mascheroni D (1991) Body position changes redistribute lung computed tomography density in patients with acute respiratory failure. Anesthesiology 74: 15–23

    Article  PubMed  CAS  Google Scholar 

  22. Gentillo L, Thompson DA, Tonnesen AS (1988) Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 16: 783–786

    Article  Google Scholar 

  23. Haslam PL, Hughes DA, McNaughton PD, Baker CS, Evans TW (1994) Surfactant replacement therapy in late ARDS. Lancet 23,343; 1009–1011

    Article  Google Scholar 

  24. Hellinger A, Konerding MA, Malkusch W, Obertacke U, Redl H, Bruch J, Schlag G (1995) Does lung contusion affect both the traumatized and the noninjured lung parenchyma? A morphological and morphometric study in the pig. J Trauma 39 (4): 712–719

    Article  PubMed  CAS  Google Scholar 

  25. Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372–377

    Article  PubMed  CAS  Google Scholar 

  26. Hoff SJ, Shotts SD, Eddy VA, Morris JA Jr (1994) Outcome of isolated pulmonary contusion in blunt trauma patients. Am Surg 60: 138–142

    PubMed  CAS  Google Scholar 

  27. Hüfner T, Schmidt U, Regel G, Zeichen J, Tscherne H (1995) Das traumatische Hochdrucködem der Lunge. Rettungsdienst 12: 6–11

    Google Scholar 

  28. Joka T, Obertacke U, Hermann J (1987) Frühdiagnostik der Lungenkontusion durch Bronchoskopie. Unfallchirurg 90: 286–291

    PubMed  CAS  Google Scholar 

  29. Khodadayan C, Hoffmann R, Neumann K, Vogl T, Pappert D, Südkamp NP (1995) Diagnostische Aussagekraft der Thorax-Computertomographie beim schweren Thoraxtrauma. Chirurg 66: 1097–1104

    Google Scholar 

  30. Kishikawa M, Yoshioka T, Shimazu T, Sugimoto H, Yoshioka T, Sugimoto T (1991) Pulmonary contusion causes long-term respiratory dysfunktion with decreased functional residual capacity. J Trauma 31 (9): 1203–1208

    Article  PubMed  CAS  Google Scholar 

  31. Kollmorgen DR, Murray KA, Sullivan JJ, Mone MC, Barton RG (1994) Predictors of mortality in pulmonary contusion. Am J Surg 168: 659–663

    Article  PubMed  CAS  Google Scholar 

  32. Lau VK, Viano DC (1981) Influence of impact velocity and chest compression on experimental pulmonary injury severity in rabbits. J Trauma 21: 1022

    Article  PubMed  CAS  Google Scholar 

  33. Lewandowski K, Pappert D, Gerlach H, Rossaint R, Kuhlen R, Falke KJ (1995) Permissive hypercapnia in the treatment of ARDS. Am J Respir Crit Care Med 151 Suppl: A 79

    Google Scholar 

  34. Liau DF, Ryan SF (1991) Effects of human PMN proteases upon surfactant protein A in vitro. Am Rev Resp Dis 143: 317

    Google Scholar 

  35. Livingston DH, Richardson JD (1990) Pulmonary disability after severe blunt chest trauma. J Trauma 30 (5): 562–566

    Article  PubMed  CAS  Google Scholar 

  36. Matamis C, Lemaire F, Harf A, Brun Buisson C, Ansquer JC, Atlan G (1984) Total respiratory pressure-volume curves in the adult respiratory distress syndrome. Chest 86: 58–66

    Article  PubMed  CAS  Google Scholar 

  37. McGonigal M, Scwab CW, Kauder DR, Miller WT, Grumbach K (1990) Supplement emergent chest computed tomography in the management of blunt torso trauma. J Trauma 30 (12): 1431–1435

    Article  PubMed  CAS  Google Scholar 

  38. Morris AH, Wallace CJ, Menlove RL et al. (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal fur adult respiratory distress syndrome [see comments] [published erratum appears in Am J Respir Crit Care Med 1994 Mar; 149 (3 Pt 1): 838]. Am J Respir Crit Care Med 149: 295–305

    PubMed  CAS  Google Scholar 

  39. Muhr G, Kayser M (1987) Mehrfachverletzungen — Rettungssysteme, Bergung und Erstversorgung. Chirurg 58: 625–630

    PubMed  CAS  Google Scholar 

  40. Obertacke U, Joka T, Jochum M, Kreuzfelder E, Schonfeld W, Kirschfink M (1991) Posttraumatische alveoläre Veranderungen nach Lungenkontusion. Unfallchirurg 94: 134–138

    PubMed  CAS  Google Scholar 

  41. Oppenheimer L, Craven KD, Forkert L, Wood LDH (1979) Pathophasiology of pulmonary contusion in dogs. J Appl Physiol 47: 718–727

    PubMed  CAS  Google Scholar 

  42. Ott R, Holzer U, Spitzenpfeil E, Kastl S, Rupprecht H, Hennig FF (1996) Lebensqualität nach iiberlebter Schwerstverletzung. Unfallchirurg 99: 267–274

    PubMed  CAS  Google Scholar 

  43. Pape H-C, Dwenger A, Regel G et al. (1994a) Increased gut permeability after multiple Trauma. Br J Surgery 81: 850–852

    Article  CAS  Google Scholar 

  44. Pape H-C, Regel G, Borgmann W, Sturm JA, Tscherne H (1994b) The effect of kinetic positioning on lung function and pulmonary hemodynamics in posttraumatic ARDS — a clinical study. Injury 25 (1): 51–57

    Article  PubMed  CAS  Google Scholar 

  45. Pape H-C, Regel G, Grotz M, Borgman W, Mehler D, Tscherne H (1994 c) Kinetische Lagerung bei posttraumatischem Lungenversagen — Pathogenetische Gesichtspunkte und Möglichkeiten des Monitoring. Anästhesiologie und Intensivmedizin 35: 89–96

    Google Scholar 

  46. Pape H-C, Remmers D, Kleemann W, Goris JA, Regel G, Tscherne H (1994 d) Posttraumatic multiple organ failure — a report on clinical and autopsy findings. Shock 2 (3): 228–233

    Article  PubMed  CAS  Google Scholar 

  47. Pape H-C, Regel G, Tscherne H (1996 a) Local and systemic effects of fat embolization after intramedullary reaming and its influence by cofactors. Techniques in Orthopedics 11 (1): 2–13

    Article  Google Scholar 

  48. Pape H-C, Regel G, Tscherne H (1996b) Controversies regarding early muskuloskeletal management in the multiple trauma patient. Curr Opin in critical care 2: 295–303

    Article  Google Scholar 

  49. Pape H-C, Remmers D, Regel G, Weinberg A, Graf B, Reilmann H, Tscherne H (1998) Is early kinetic positioning beneficial for pulmonary function in multiple trauma patients? Injury 8: 2–13

    Google Scholar 

  50. Pape H-C, Remmers D, Schedel I, Glinski S, Dahlweit M, Oberbeck R, Tscherne H (1999) Levels of antibodies to endotoxin and cytokine release in patients with severe trauma. J Trauma 46,3: 34

    Article  Google Scholar 

  51. Pape H-C, Remmers D, Grotz M, Kotzerke J, Glinski S, Sznidar S, Tscherne H (1999) Reticuloendothelial system activity and organ failure in multiply injured patients. Arch Surg 134: 421–427

    Article  PubMed  CAS  Google Scholar 

  52. Pape H-C, Meier R, Sturm JA (1999) Physiologic changes following infusion of colloids or crystalloids. J Intens Care

    Google Scholar 

  53. Pate JW (1989) Chest wall injuries. Surg Clin North Am 69 (1): 59–70

    PubMed  CAS  Google Scholar 

  54. Payne EM (1909) Contusion of the lung without external injuries. Br Med J 1: 139–142

    Article  PubMed  CAS  Google Scholar 

  55. Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ (1982) Clinical predictors of the adult respiratory distress syndrome. Am J Surg 144: 124–130

    Article  PubMed  CAS  Google Scholar 

  56. Pichlmaier H, Zieren HU (1989) Lung injuries. Langenbecks Arch Chir 374: 131–137

    Article  PubMed  CAS  Google Scholar 

  57. Piligram-Larsen J, Lovstakken K, Hafsahl G, Solheim K (1993) Initial axial computerized tomography examination in chest injuries. Injury 24 (3): 182–184

    Article  Google Scholar 

  58. Pison U, Obertacke U, Seeger W, Hawgood S (1992) Surfactant protein A is decreased in acute parenchymal lung injury associated with polytrauma. Eur J Clin Invest 22 (11): 712–718

    Article  PubMed  CAS  Google Scholar 

  59. Regel G, Sturm J, Neumann C, Schueler S, Tscherne H (1989) Occlusion of bronchopleural fistula after lung injury — a new treatment by bronchoscopy J Trauma 29: 1–4

    Article  Google Scholar 

  60. Regel G, Dwenger A, Schweitzer G, Sturm JA (1990) Cellular mechanisms contributing to the development of ARDS following lung contusion. Theor Surg 5: 180–184

    Google Scholar 

  61. Regel G, Seekamp A, Aebert H, Wegener G, Sturm JA (1990) Bronchoscopy in severe blunt chest trauma. Surg Endosc 4: 31–35

    Article  PubMed  CAS  Google Scholar 

  62. Regel G, Dwenger A, Gratz KF, Nerlich ML, Sturm JA, Tscherne H (1989) Humorale und zelluläre Veränderungen der unspezifischen Immunabwehr nach schwerem Trauma. Unfallchirurg 92: 314–320

    PubMed  CAS  Google Scholar 

  63. Regel G, Sturm JA, Friedl HP, Nerlich M, Bosch U, Tscherne H (1988) Die Bedeutung der Lungenkontusion für die Letalität nach Polytrauma. Möglichkeiten der therapeutischen Beeinflussung. Chirurg 59: 771–776

    PubMed  CAS  Google Scholar 

  64. Regel G, Sturm JA, Neumann C, Bosch U, Tscherne H (1987) Bronchoskopie der Lungenkontusion bei schwerem Thoraxtrauma. Unfallchirurg 90: 20–26

    PubMed  CAS  Google Scholar 

  65. Rhea JT, Novelline RA, Lawrason J, Sacknoff R, Oser A, (1989)The frequency and significance of thoracic injuries detected on abdominal CT scans of multiple trauma patients. J Trauma (29) 4: 502–505

    Article  Google Scholar 

  66. Ribet M, Woelffle D, Bollengier D, Hassoun A, Pruvot FR, Giard Lefevre S (1987) Diffuse pulmonary contusion. Press Med 16: 578–581

    CAS  Google Scholar 

  67. Richardson JD (1985) Indications for thoracotomy in thoracic trauma. Curr Surg Sept-Oct: 361–364

    Google Scholar 

  68. Scalea TM, Hartnett RW, Duncan AO et al. (1990) Central venous oxygenation saturation: A useful clinical tool in trauma patients. J Trauma 30: 1539–1543

    Article  PubMed  CAS  Google Scholar 

  69. Schaal MA, Fischer RP, Perry JF Jr (1979) The unchanged mortality of flail chest injuries. J Trauma 19: 492–496

    PubMed  CAS  Google Scholar 

  70. Schild HH, Strunk H, Stoerkel S et al. (1986) Computertomographie der Lungenkontusion. Fortschr Rontgenstr 145 (5): 519–526

    Article  CAS  Google Scholar 

  71. Schild HH, Strunk H, Weber W, Stoerkel S, Doll G, Hein K, Weitz M (1989) Pulmonary contusion: CT vs plain radiograms. J Computer Ass Tomography 13 (3): 417–420

    Article  CAS  Google Scholar 

  72. Schimmel L, Civetta L, Kirby RR (1977) A new mechanical method to influence pulmonary perfusion in critically ill patients. Crit Care Med 5: 277–279

    Article  PubMed  CAS  Google Scholar 

  73. Seeger W, Gunther A, Walmrath AD, Grimminger F, Lasch HG (1993) Alveolar surfactant and ARDS. Clin Invest 71 (3): 177–190

    Article  CAS  Google Scholar 

  74. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A (1987) Blunt thoracic trauma. Ann Surg 206 (2): 200–205

    Article  PubMed  CAS  Google Scholar 

  75. Stellin G (1991) Survival in trauma victims with pulmonary contusion. Am Surg 57: 780–784

    PubMed  CAS  Google Scholar 

  76. Suchyta MR, Elliott CG, Jensen RL, Crapo RO (1993) Predicting the presence of pulmonary function impairment in adult respiratory distress syndrome survivors. Respiration 60: 103–108

    Article  PubMed  CAS  Google Scholar 

  77. Staub NC (1974) Pulmonary edema. Physiol Rev 54: 678–811

    Article  PubMed  CAS  Google Scholar 

  78. Sturm JA (1989) Das frühe alveolare Lungenödem nach Trauma — ein differenzierbares Krankheitsbild. Hefte Unfallk 207: 50–51

    Google Scholar 

  79. Svennevig JL, Vaage J, Westheim A, Hafsahl G, Refsum HE (1989) Late sequelae of lung contusion. Injury 20 (5): 253–256

    Article  PubMed  CAS  Google Scholar 

  80. Temmesfeld-Wellbruck B, Walmrath D, Grimmiger F, Seeger W (1995) Prevention and therapy of the ARDS. Lung 173 (3): 139–164

    Article  Google Scholar 

  81. Tuxen DV (1994) Permissive hypercapnia. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 371–392

    Google Scholar 

  82. Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP (1996) Behandlungsergebnisse der operativen Thoraxwandstabilisierung bei instabilem Thorax mit und ohne Lungenkontusion. Unfallchirurg 99: 425–434

    PubMed  CAS  Google Scholar 

  83. Wagner RB, Crawford WO, Schimpf PP (1988) Classification of parenchymal-injuries of the lung. Radiology 167: 77–82

    PubMed  CAS  Google Scholar 

  84. Wagner RB, Jamieson PM (1989) Pulmonary contusion — evaluation and classification by computed tomography. Surg Clin North Am 69 (1): 31–40

    PubMed  CAS  Google Scholar 

  85. Wagner RB, Slivko B, Jamieson PM, Dills MS, Edwards FH (1991) Effect of lung contusion on pulmonary hemodynamics. Ann Thorac Surg 52: 51–58

    Article  PubMed  CAS  Google Scholar 

  86. Walz M, Muhr G (1992) Die kontinuierliche wechselnde Bauchlagerung beim akuten Lungenversagen. Chirurg 63: 931–937

    PubMed  CAS  Google Scholar 

  87. West JB (1977) Pulmonary blood flow. In: West JB (ed) Regional differences in the lung. Academic Press, New York San Francisco London

    Google Scholar 

  88. Withe RD, Lipton MJ, Higgins CB et al. (1986) Noninvasive evaluation of suspected thoracic aortic disease by contrast-enhanced computed tomography. Am J Cardiol 57: 282–290

    Article  Google Scholar 

  89. Zack MB, Pontoppidan H, Kazemi H (1974) The effect of lateral positions on gas exchange in pulmonary disease — a prospective evaluation. Am Rev Resp Dis 110: 49–55

    PubMed  CAS  Google Scholar 

  90. Ziegler DM, Agarwal NN (1994) The morbidity and mortality of rib fractures [see comments]. J Trauma 37: 975–979

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. G. Regel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-C. Pape
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz

    Otmar Trentz

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Regel, G., Pape, HC. (2000). Lungenkontusion. In: Trentz, O. (eds) Tscherne Unfallchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56941-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-56941-8_7

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-63282-5

  • Online ISBN: 978-3-642-56941-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation