Thoracic Manifestations of Blast Injury: A Walter Reed Experience.
Retrospective review of radiologic studies, between Jan 04-Jan 05, of war injuries at WRAMC identifying those patients with hitory of blast injury. The CT studies were reviewed by two staff radiologists and characterized as well as graded into the following categories: pulmonary contusion, pneumothorax, consolidation, atelectasis, effusions, ARDS, and injuries of the chest wall, cardiac, vascular, airway or extrathoracic compartments.
Of 196 war patients identified, 83 documented blast injury patients were selected. Thirty seven patients had pulmonary contusions; associated findings from this group include 23 patients with chest wall/musculoskeletal injuries, 21 with pneumothorax and 20 with effusions. The most common manifestations of 86 patients were effusions (58) and atelectasis (46). Of the 58 patients with effusions, 55 had associated extrathoracic injuries including extremities (32), abdomen/pelvis (27), head (18) and others (3). Other pulmonary manifestations include consolidation/airspace disease (24), ARDS (9), PE (6), documented infections (4) and presumed fat emboli (2). Non-pulmonary manifestations include pericardial effusions (9), direct vascular injuries (2), lung resection (1), major airway laceration (1), and mediastinal hematoma (1).
While effusions and atelectasis are the most common intrathoracic findings, they are most closely associated with extrathoracic injuries. The most common clinically relevant pulmonary manifestation is pulmonary contusion which is strongly associated with pneumothoraces and chest wall/musculoskeletal injuries, i.e. direct blast lung injury. In patients with predominantly pulmonary injuries and less commonly associated cardiovascular or intra/extrathoracic musculoskeletal injuries, there is reduced morbidity/mortality.
Further understanding of the mechanisms of direct blast lung injury and associated intra/extrathoracic manifestations will enhance prediction of long-term prognosis of these conditions. In addition, recognizing the patterns of pulmonary manifestations of blast injuries may provide an optimal work-up algorithm for efficient and accurate triage and treatment of blast victims in military or civilian armed crises.