Cruisin’ for a bruisin’: Pulmonary contusion

Case presentation

A 13-year-old is brought to the Emergency Department after being struck by a large truck while attempting to cross a highway on his bicycle. There is no reported loss of consciousness. His vital signs show an afebrile patient with a heart rate of 120 beats per minute, respiratory rate of 28 breaths per minute, blood pressure of 100/70 mm Hg, and a pulse oximetry reading of 91% on room air. He is conversing on arrival and has bruising over the lower medial right side of his neck and upper- and mid-chest, bilaterally. He states his right collar bone hurts and he has bilateral chest pain, left more than the right, while taking deep breaths. There is no crepitus. He has some mild abdominal pain to the left upper quadrant. He also has an obvious deformity to his left lower extremity but is neurovascularly intact. His Glasgow Coma Scale score is 14.

Imaging considerations