Silent Impact: Acute Respiratory Distress Syndrome Induced Delayed Pulmonary Contusion Without External Trauma Signs

Abstract

Pulmonary contusion is the most common parenchymal injury following blunt thoracic trauma. It is defined as damage to the alveolar–capillary membrane, leading to alveolar hemorrhage and interstitial edema without macroscopic laceration of the lung tissue. Pulmonary contusion should be suspected in any patient with blunt chest trauma who develops unexplained hypoxemia or respiratory distress. We report a case of a patient who sustained high-energy blunt trauma without external bruising or radiologic evidence of pulmonary contusion, yet developed acute respiratory distress syndrome (ARDS) secondary to pulmonary contusion within 48 hours, despite an uncomplicated surgical course. This case highlights the importance of early recognition and close monitoring of ARDS secondary to pulmonary contusion to reduce mortality. Delayed onset pulmonary contusion often poses a diagnostic challenge, as initial imaging may appear normal while microvascular injury continues to evolve leads to eventual respiratory failure. Therefore, continuous clinical assessment and serial imaging are essential, particularly in patients with high-energy trauma, even in the absence of overt thoracic findings. Early diagnosis and timely intervention remain key determinants of patient outcomes.