[Role of diagnostic imaging in the assessment of lung complications of burns].
OBJECTIVE
We investigated the frequency of pulmonary complications in burn patients and the clinical and prognostic role of chest radiography and CT patterns in these patients.


METHODS
We examined 203 patients with first- to third-degree burns involving up to 90% of the body surface; the patients were 119 men and 84 women ranging in age 1 to 96 years (mean: 30). Burns on the face, sooth in the sputum and fire in an unventilated area indicated smoke inhalation in three patients. All patients were submitted to bedside chest radiography on hospitalization and the examination was repeated during the hospital stay in 26 patients. Seven patients with pulmonary complications also underwent chest CT. Five patients with severe, extensive burns (> 70% of the body surface) and with no clinical signs of respiratory complications were submitted to HRCT within 48 hours of admission.


RESULTS
Lung complications developed in 16 patients (7.8%), leading to clinical and radiographic signs of adult respiratory distress syndrome (ARDS) in 11 of them (5.4%), namely 5 women and 6 men (age range: 19-96 years, mean: 50). Only one of the three patients with smoke inhalation developed ARDS. The extension of burn injuries ranged 18-86% of the body surface. ARDS developed within 12 hours-14 days of injury (mean: 8 days). Four patients (36%) had right lung involvement alone, two (18%) had bilateral, mostly right-lobe, abnormalities, and five patients (46%) had frankly bilateral findings; the latter were associated with pleural effusions in the left lower lobe in one patient. Compared with chest radiography, HRCT always identified the initial signs of interstitial edema and subpleural emphysematous bullae were detected in a patient who subsequently exhibited clinical and radiographic signs of ARDS. Nine (82%) of the 11 ARDS patients died of respiratory insufficiency. Most deaths (6 patients, 67%) occurred within a few hours of the onset of distress; in three patients with unilateral pulmonary edema death occurred within 6, 7 and 8 days, respectively. ARDS patients had significantly larger body surface areas burned and higher incidence of third-degree burns.


CONCLUSIONS
The incidence of radiologically confirmed pneumonia was 1%; the causative pathogens were Pseudomonas aeruginosa and Staphylococcus aureus. HRCT detected a pneumatocele in a patient with Staphylococcus pneumonia. One patient had eosinophilic pleurisy and another a pulmonary microembolization. The overall mortality in our patients with burns and pulmonary complications was 56% versus 2% in the rest of the series, which confirms the importance of an early diagnosis to optimize treatment planning in such cases. For these reasons CT, and particularly HRCT, studies can be best because these techniques can show even minimal parenchymal changes. These examinations will be increasingly feasible also in critically ill and barely movable patients thanks to the latest mobile CT units which permit scanning also in intensive and subintensive care units.
Sergiacomi
G L
GL
Istituto di Radiologia, Università degli Studi Tor Vergata, Roma.
Mazzetti di Pietralata
G
G
Moscone
A
A
Ciorra
D M
DM
Motta
M R
MR
Palmisano
P
P
Simonetti
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed