PMC7269769_01
Contrast-enhanced computed tomography scan (CE-CT) of a 34-year-old man on day 1 (A), day 4 (B), day 21 (C), and 6 months (D) after a traumatic lung injury. A, Multiple large pneumatoceles (arrows) and hemopneumothorax on the right. B, CE-CT several hours after the initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO). Entire right lung and right lumen of the double-lumen tube (DLT) is filled with blood due to hemoptysis. Tip of the left DLT is in an appropriate position (arrowhead). C, CE-CT after removal of V-V ECMO. Pneumatoceles remain but pulmonary contusion has healed. D, Confirmed complete resolution of the pneumatoceles at outpatient follow-up 6 months after the injury.
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Contrast-enhanced computed tomography scan (CE-CT) showed bilateral pulmonary contusions and hematomas with multiple traumatic pneumatoceles on the right lung (Fig. 1A), right hemopneumothorax, bilateral multiple rib fractures, right scapula fracture, a sternal fracture, and a minor liver injury. Pulmonary contusion and multiple pneumatoceles eventually resolved 6 months after the injury (Fig. 1B-D).
Clinical course of a 34-year-old man with massive hemoptysis after a traumatic lung injury. DeltaP, driving pressure; ACT, activated clotting time; APTT, activated partial thromboplastin time; ECMO, extracorporeal membrane oxygenation; PEEP, positive end-expiratory pressure; PS, pressure support; V-V ECMO, veno-venous ECMO. A/C, SIMV, and BILEVEL indicate ventilation modes of Puritan Bennett  840 Ventilator (Medtronic, Boulder, CO, USA).
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However, on day 2, he suddenly developed massive hemoptysis with his PaO2/FiO2 ratio (P/F ratio) falling to 41.1 (Fig. 2).