Lung injury: spectral insights

29 yo F pedestrian stuck by car, and thrown unknown feet. Patient intubated at the scene and brought to the ED.

Trauma pan scan obtained. Right lung shows extensive lung contusions, and several lung lacerations.

On spectral analysis, the central pneumatocele portion of the lung lacerations shows no perfusion, as expected. interestingly, there is increased perfusion around the pneumatocele, and increased perfusion in the contused lung compared to the contralateral left lung anteriorly.

While I am not sure regarding explanation of this "luxury" perfusion, I feel it is most likely related to capillary injury and increased permeability. If this is true, this might account for the penomenon of rapid worsening of infiltrates in case of lung injury.

Conventional CT shows mutiple right lung lacerations. Note the right hemo-pneumothorax.

Iodine map shows increased perfusion surrounding the lung lacerations. There is also increased perfusion in the area of lung contusion compared to contralateral lung.

Fusion image nicely demonstrates the perfusion alterations.