Management in the ED

Patients may show no signs of external trauma, but usually have clinical and radiological evidence of blast lung at the time of presentation to hospital [5,6,9].

They may, however, be asymptomatic in early stages [1,6].

It is vital to measure pulse oximetry in all patients and a decrease in peripheral oxygen saturation may be the earliest sign of the development of blast lung.

Other symptoms include:

  • Breathlessness
  • Chest pain
  • Wheeze and cough with haemoptysis

On examination, there may be:

  • Tachypnoea
  • Dyspnoea
  • Increased work of breathing
  • Cyanosis

On auscultation there may be:

  • Absent or reduced breath sounds
  • Altered percussion note
  • Wheeze or crepitations [5,9]
Chest radiographs

Chest radiographs should be performed on all patients and their findings will vary depending on the exact pathology within the lung.

All may occur in isolation or in combination and most will be detectable on chest radiographs at presentation. The following are typical findings in blast lung:

  • Butterfly distribution of opacification
  • Pulmonary haemorrhage
  • Pulmonary oedema
  • Contusion
  • Pneumothorax
  • Haemothorax
  • Pneumomediastinum
  • Subcutaneous emphysema
  • Pleural laceration
  • Parenchymal laceration

Most commonly a butterfly distribution of bilateral pulmonary infiltrates is observed [8]. The mediastinum is thought to reflect blast forces, increasing the blast load affecting the lung parenchyma surrounding the central structures [6].