Platinum Trauma Practice Exam

Why might pulmonary contusion be missed on initial chest X-ray?

Contusions may evolve and become apparent later X-ray is more sensitive early than CT They always appear immediately They cannot occur

Correct Answer:

Contusions may evolve and become apparent later

Explanation:

Pulmonary contusion often isn’t visible right away because the injury causes edema and small hemorrhages that take time to develop to radiographically detectable levels. After blunt trauma, an initial chest X-ray can appear normal or show only subtle changes, while the edema and hemorrhage evolve over hours. As these changes become more pronounced, patchy air-space opacities emerge, revealing the contusion. CT is more sensitive early on and can pick up smaller or early injuries that a plain X-ray misses, which is why the contusion might be detected later on X-ray but could be seen sooner with CT. So the reason it can be missed initially is that contusions may evolve and become apparent later.

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