Radiographic manifestations of acute smoke inhalation

Putman, Charles E.; Loke, Jacob; Ra, Matthay; Ravin, CE

doi:10.2214/ajr.129.5.865

Cited by 47 publications

(16 citation statements)

References 11 publications

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“…22 Hypoxemia, rales, rhonchi, and wheezes are seldom present on admission, occurring only in those with the most severe injury and implying an extremely poor prognosis. 23 It has been reported that respiratory dysfunction in these patients may be underestimated owing to initially misleadingly normal blood gases and chest radiography 24,25 (Fig. 1).…”

Section: Diagnosismentioning

confidence: 98%

Smoke Inhalation Injury of Indoor Fire

Capdevila

Irrazabal

2009

Clinical Pulmonary Medicine

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Smoke inhalation injury can be considered as a systemic disease. Early mortality and systemic involvement are due to the severity of thermal injury of the upper airway and to CO poisoning associated with other combustion materials. Prompt administration of 100% oxygen therapy is crucial. Laryngoscopy is useful because it may show pharyngeal or laryngeal mucosal injury despite the absence of respiratory symptoms and consequently the need for endotracheal intubation. Bronchoscopy is useful in identifying severity of airway injury and performing bronchial toilet and BAL culture, thus allowing early diagnosis of pulmonary infections and the adjustment of antibiotic treatment. Corticosteroid therapy should be considered when persistent acute respiratory distress syndrome, interstitial pneumonia, or obliterans bronchiolitis is suspected without evidence of active infection. Obstruction airway disease can persist several months after the smoke inhalation.H ouse fires, explosions, and others disasters involving fire and smoke in closed buildings can result in a serious health threat to victims because of both burns and smoke inhalation. People exposed to indoor fire and smoke inhalation often die because they are unable to escape from the toxic effects of carbon monoxide (CO) and combustion products. 1 A review of factors involved in different fires suggests that most deaths are not due to flame contact or high doses of CO but are a consequence of the presence of nitrogen oxides and other combustion products such as hydrogen cyanide, hydrogen chloride (the main pyrolysis product of polyvinyl chloride), and other hydrocarbons. 2,3 The mortality rate of smoke inhalation among burn victims is above 30% and falls to 10% among persons without burns. 4,5 Inhalation injury, the size of burns over 40% of the body surface, and the age are the most important factors in the length of hospitalization in the intensive care unit 6 and death. 7 The terms "smoke inhalation" or "inhalation injury" describe the aspiration of superheated gas and toxic products of incomplete combustion, resulting in airway or pulmonary parenchymal injury with a wide range of severity in patients with and without skin burns. 4 Different degrees of acute lung injury (ALI) and several physiological derangements can cause a low ventilation/perfusion ratio. Pneumonia and tracheobronchitis secondary to the loss of ciliary clearance by the tracheal and bronchial epithelium 8 are frequent complications.The aim of this review is to analyze different aspects of the acute lung injury of smoke inhalation, the systemic involvement, and some treatment strategies that should be planned.

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Section: Diagnosismentioning

confidence: 98%

Smoke Inhalation Injury of Indoor Fire

Capdevila

Irrazabal

2009

Clinical Pulmonary Medicine

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“…It was noted that lung fibrosis significantly improved ( Figure 2H). The median of LFCTS of these three CT scans (1st, 8th and 15th, Oct) were 3 (range, 0-4), 9 (range, 6-14) and 6 (range, [3][4][5][6][7][8][9][10][11][12] respectively. In one patient, the initial scan showed patterns like layered cake, consolidation with air bronchus signs in the accumulation area, GGOs in the aforementioned area, and normal lung in the top area.…”

Section: Clinical Parametersmentioning

confidence: 99%

“…A number of studies have already focused on clinical, radiographic, and pulmonary function of smoke inhalation (3)(4)(5)(6)(7). Some studies showed that the chest radiograph is an insensitive indicator of inhalation of airway and parenchymal lung injury (8,9). Therefore, computed tomography (CT) was used by radiologists to diagnose the inhalation lung injury.…”

Section: Introductionmentioning

confidence: 99%

Inhalation lung injury induced by smoke bombs in children: CT manifestations, dynamic evolution features and quantitative analysis

Zhang

Zhao

et al. 2018

J. Thorac. Dis

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Background: This retrospective study aimed to investigate the computed tomography (CT) manifestations, short-term dynamic evolution features and quantitative lung CT analysis of inhalation lung injury induced by smoke bomb flare.Methods: Eleven pediatric patients (aged 11 to 13) who inhaled the smoke of smoke bombs underwent several low-dose chest CT scans. The image characteristics and their dynamic changes were observed and quantitative CT values were analyzed. The quantitative CT indicators included lung injury CT score (LICTS), lung fibrosis CT score (LFCTS), mean lung density (MLD), normally aerated volume ratio (NAVR) and reductively aerated volume ratio (RAVR). Box-plot was used to analyze the dynamic changes of each indicator and Spearman statistical method was used to analyze the correlation between any two indicators. Results: (I) In most cases, there were multiple consolidation and massive ground-glass opacities (GGOs) in the two lungs, which aggravated in the early stage and then gradually dissoluted in the later stage. LICTS was positively correlated with MLD (r=0.811, P=0.000), while it was negatively correlated with NAVR (r=−0.712, P=0.000). There existed interstitial fibrosis in the later stage, and LFCTS was positively correlated with RAVR (r=0.382, P=0.028). (II) In one case, the patterns were like layered cake, i.e., consolidation with air bronchus signs in the accumulation area, GGOs in the aforementioned area and normal lung in the top area. The patterns aggravated in the early stage and quickly dissolved in the later stage, and only a few residual fibrotic lesions existed on the final scan. (III) For severe cases, pneumomediastinum and subcutaneous emphysema aggravated in the early stage and then gradually dissolved in the later stage. Conclusions: The chest CT manifestations of inhalation lung injury induced by smoke bombs are predominantly GGOs and consolidation. They aggravate in the early stage and gradual dissolute in the later stage. CT quantitative values can contribute to evaluating the extent of this disease, and NAVR and RAVR can be used to assess pulmonary function.

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“…Die meisten Brandverletzten zeigen bei Aufnahme keine Verände-rungen in der Röntgenaufnahme des Thorax [21]. Veränderungen des Lungenröntgens innerhalb der ersten Tage nach dem Trauma wurden als Indiz für ein spätes Inhalationstrauma bezeichnet, dürften aber nach heutigem Wissensstand hauptsächlich iatrogen bedingt sein und mit der oftmals exzessiven Flüssigkeitssubsti-tution in Zusammenhang stehen (siehe Kapitel Therapie).…”

Section: Diagnoseunclassified

Das Inhalationstrauma – Epidemiologie, Diagnostik und Therapie

Thaler

Kraincuk

Kamolz

et al. 2010

Wien Klin Wochenschr

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Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.

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Radiographic manifestations of acute smoke inhalation

Cited by 47 publications

References 11 publications

Smoke Inhalation Injury of Indoor Fire

Smoke Inhalation Injury of Indoor Fire

Inhalation lung injury induced by smoke bombs in children: CT manifestations, dynamic evolution features and quantitative analysis

Das Inhalationstrauma – Epidemiologie, Diagnostik und Therapie

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