Contusion

Contusion is a closed mechanical damage to soft tissues or internal organs without a visible violation of their anatomical integrity.

Concussion occurs as a result of a blow by a blunt solid object or when it falls on a hard surface. When the internal organs are damaged, either a direct action of the traumatic agent takes place, an attack on the light or liver with a displaced rib, a blow to the brain with a displaced bone fragment with depressed fractures; or develops a mechanism of deceration when the organ is inertially displaced with a blow against the wall, for example, the brain about the cranium, the lungs against the chest wall, etc. Clinically superficial concussion in most cases gives local changes. The contusion of the internal organs forms a systemic pathology, and sometimes has serious complications in the form of ruptures, sometimes biphasic, bleeding, etc.

Superficial concussion

The severity of the injury depends on the area of application of force, the direction of the impact, the kinetic energy of the damaging agent. When striking at an angle of 90 degrees to the surface of the body, the integrity of the skin is not impaired because of the high strength and stability of the skin to mechanical stress. But at a large kinetic energy (more than 2 kg / cm2) can be formed bruised wounds. When the impact is applied at an angle of 30-75 degrees to the surface of the body, skin deposits form, and at a sharper angle of application of force, detachment occurs with the development of subcutaneous hematoma due to tangential action on soft tissues and skin.

Clinical manifestations depend on the place of application of force. Uncomplicated concussion in the soft tissue area is clinically accompanied by pain at the moment of concussion, which quickly subsides, and after 1-2 hours it is reinforced already by irritation of nerve endings with edema and bruising (alteration). The color of the bruise determines the time of injury: the first 2 days it has a purple-violet hue; up to the 5th-6th day - blue; before 9-10th day - green; before the 14th day, yellow - gradually fades as hemosiderin resorption.

Complicated include: concussion in the joints, which gives hemarthrosis; contusion in the head, spine, thorax and abdomen, where internal organs are often damaged. A concussion with high kinetic energy in the bone region leads to their fractures. Strikes against certain points or zones can cause a shock reaction, up to a lethal outcome.

The contusion of organs

Diagnosis of brain damage

There are concussions and bruises of the brain of three degrees of severity. The main differential-diagnostic symptom of the presence of brain trauma and its severity is loss of consciousness. Other symptoms play a supporting role and should be performed by a neurosurgeon.

The concussion of the brain is an easy and reversible form of craniocerebral trauma with predominantly functional disorders of the central nervous system. But the outcome of the injury largely depends on the correctness of the treatment and, most importantly, on the observance of the terms of bed rest. What is difficult for such victims to achieve, because they are unaware of the severity of the damage (a symptom of Anton-Babinsky).

The main criterion for diagnosing a concussion of the brain is a brief loss of consciousness from a few seconds to 30 minutes. The pathological anatomy of the concussion of the brain is its edema and swelling (alteration). As the edema and swelling of the brain stop, the damage phenomena quickly regress.

Clinically, concussion is accompanied by: headaches, dizziness, weakness; nausea and vomiting may occur, which quickly stop. Characteristic: horizontal nystagmus, reduced response of pupils to light irritation, smoothness of nasolabial fold, which also quickly stop. Pathological meningeal reflexes are not detected. Cerebrospinal fluid is normal. Sometimes vegetative disorders are noted in the form of: increased blood pressure, tachycardia, increased body temperature, rapid breathing, which quickly pass.

Contusion has a pronounced pathologoanatomic substrate: in the form of subarachnoid hemorrhages (planar or wedge shaped, extending into the brain) in the area of application of force; hemorrhagic softening and foci of destruction. Most often, foci of bruises form in the cerebral cortex or cerebellum; less often in the brainstem; or in various combinations of hemispheric and cerebellar foci. The severity of injuries and clinical manifestations distinguish three degrees of contusion.

[1], [2],

Contusion of the I degree

With bruises of the first degree, small subarachnoid hemorrhages form; swelling and swelling. Loss of consciousness is from 30 minutes to 1 hour. Clinical manifestations are more pronounced than with a concussion: they are long, persistent, they can grow from the 2-3rd day after the injury, their regression is long and occurs no earlier than 2 weeks after the trauma. A distinctive feature is a symptom of retrograde amnesia, when the victim can not remember the circumstances of the injury. It does not appear in all cases, but it is pathognomonic for the bruises of the brain. With bruises of the 1st degree, this symptom is transient, it stops within a week. Paralysis and paresis is not observed.

Neurological symptoms after recovery of consciousness clear: worried headaches, dizziness, nausea; vomiting is rare. On examination: horizontal nystagmus, reduced pupillary response to light, nasolabial fold flattening. When examining peripheral innervation, the asymmetry of reflex excitability. Vegeto-vascular changes do not differ from manifestations in concussion of the brain.

Contusion of II degree

The anatomical substrate that determines this degree of injury is the development of planar subarachnoid hemorrhages, sometimes occupying entire fields. Loss of consciousness from 1 to 4 hours. Sometimes there are respiratory and cardiac disorders requiring replacement therapy, right up to resuscitation benefits, but compensation, with adequate treatment, occurs within the first 24 hours.

Clinically after the restoration of consciousness, concussion of the second degree is accompanied by severe headaches, dizziness, lethargy, adynamia; Retrograde amnesia is prolonged (from a week to several months), but transient.

On examination: pronounced horizontal nystagmus; smoothness of the nasolabial fold; rigidity of the occipital muscles, dissymmetry of peripheral reflexes; may occur hemiparesis or hemiplegia; plantar reflex, reflexes of Kernig and Babinsky. But all these symptoms and syndromes are transitory, albeit prolonged. Most often, the process ends with the formation of areas of brain dystrophy or fusion of the meninges, which determines the mass of neuropathological conditions in the post-traumatic period.

Contusion of III degree

The anatomical substrate that determines the development of a third degree injury is: extensive subarachnoid hemorrhages in the zone of impact and counterblow, as well as hemorrhages in the brain tissues, sometimes even in the ventricles of the brain. In fact, such damage can be defined as a hemorrhagic stroke.

The clinic is expressed in the form of a prolonged loss of consciousness, more than 4 hours; persistent hemiparesis; disorders of craniocerebral innervation, the presence of symptoms of Kernig and Babinsky.

Diagnosis of contusion damage and differential diagnosis with intracranial and intracerebral hematomas, with which this concussion often combines, should be carried out in specialized neurosurgery and resuscitation departments, where the victims and hospitalized for emergency care.

Contusions of other organs

In 5-7% of cases of a trauma of a breast, especially if blow it is necessary on forward departments of a thorax and a breast bone, the obvious contusion of heart forms. Clinically, and according to ECG data, they are similar to myocardial infarction. In 43-47% of cases of closed chest trauma, there is a hidden contusion of the heart, which gives a clinical picture of IHD, but the cause of it is revealed only with special studies.

Kontusia of the kidneys is noted quite often, especially with polytrauma. The main criterion for the diagnosis is the presence of obvious hematuria or microhematuria. A complete examination should be performed by a urologist for differential diagnosis with damage to other parts of the genito-urinary tract.

The diagnosis of concussion of the liver and spleen is competent, but the diagnosis is very difficult at low severity, and heavier bruises form subcapsular ruptures. The same applies to bruises of hollow organs.

[3], [4], [5], [6]

Diagnosis of concussion lesions of the lungs

In 42-47% of isolated chest trauma and 80-85% of combined injuries, lung contusions are formed. As a rule, they are formed by falling on the ledge or from a height of more than two meters, or when there is inertial displacement of the lung with a blow against the chest wall, for example, with auto-trauma.

During the first 6 hours, pronounced dyspnea, weakened breathing. After that, there is an improvement in the condition, the clinic is smoothed out, but on the 2-3rd day after the trauma there is a characteristic deterioration of the condition: chest pains increase, dyspnea appears again, physical and radiological changes are formed, which determine three degrees of heaviness of the lung or lung contusion.

[7], [8]

Contusion of the I degree

They are accompanied by the formation of alterative pneumonitis (not to be confused with pneumonia - purulent inflammation of the terminal sections of lung tissue) due to edema and hemorrhages into individual lobules of the lungs (hemoptysis is extremely rare - in 7% of cases).

Again, there are pains in the chest with breathing and coughing, mild cyanosis and shortness of breath, there may be a low-grade fever. Auscultatory: weakened breathing with small bubbles or creping rales. On the radiographs of the lungs, more often in the lower lobe, multiple, small, medium intensity, fuzzy darkening of the lung tissue are detected, there may be Curly lines (horizontally located, weakly intensive lines of darkening along the lymphatic vessels). Deterioration continues until the 6th-7th day after injury with subsequent improvement.

[9], [10]

Contusion of II degree

They are accompanied by the formation of exudative hemoplethritis with the localization of effusion in the cidoid diaphragmatic sinus or interstitial sulcus. Dyspnea and cyanosis are more pronounced, there is a clinic for pleural syndrome. On the radiographs of the lungs, homogeneous uniform darkening in the zone of effusion localization.

[11], [12], [13], [14],

Contusion of III degree

They are accompanied by the formation of hemoaspiration or lung atelectasis with the development of respiratory failure syndrome. Forms a pronounced hypoxic syndrome, respiratory distress syndrome. On radiographs of the lungs: with hemoaspiration, multiple bilateral darkening of the lung tissue as a "snow blizzard"; with atelectasis of the lung - homogeneous darkening of the lung with a shift of the mediastinum towards the dimming.

[15]