Transcript MDCT findings of lung parenchyma high voltage

Aguilar Arjona J.A., Santos Armentia E., Castellón Plaza, Calatayud Moscoso del
Prado J., Tardáguila de la Fuente G., D. Prada Gonzalez R., Silva Priegue N.,
Gonzalez Vazquez M.
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To show the imaging findings of MDCT in high
voltage electrical burn of the lung parenchyma.
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Approximately 20% of all electrical injuries occur in
children. Most electrical injuries that occur in children
are at home with extension cords (60-70%) and wall
outlets (10-15%) being by far the most common sources
in this age group.
In adults, most electrical injuries happen at the
workplace and constitute the fourth leading cause of
work-related traumatic death. One third of all electrical
traumas and most high-voltage injuries are job related.
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More than 50% of these occupational electrocutions
result from power line contact (5-6% of all work-related
deaths), and 25% result from using electrical tools or
machines. The annual occupational death rate from
electricity is 1 death per 100,000 workers, with a maleto-female ratio of 9:1.
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We report a case of direct electrical injury of the lung
parenchyma.
Electrical injuries have become a more common form
of trauma with unique pathophysiology and with high
morbidity and mortality.
Damage to the lung is rare because the air in the lungs
is a poor conductor of electricity.
More commonly, blunt pulmonary trauma occurs from
falls or other associated events.
Respiratory arrest may result from tetanic contraction
of the diaphragm. Aspiration pneumonia and
pulmonary edema are not a direct result of
electrocution.
After direct contact with a high voltage
wire, the electric current went through the
head to the anterior chest wall. This caused
a skin burn and lung damage along the
electric path in the parenchyma.
After direct contact
with the high voltage
wire…
Soft tissue damage on
parietooccipital region
and left anterior chest
wall.
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This caused lung damage along the electric
path in the parenchyma.
Skin burn
Patchy areas of
pneumonitis
MDCT shows patchy areas
of pneumonitis in the
direction of the beam in the
upper lobes and posterior
segments of the inferior
lobes. Below the level of the
soft tissues damage, no lung
parenchyma alterations were
seen.
Other imaging findings of electrical lung injury:
 Lung infarction due to coagulation necrosis.
 Bronchiolitis, pneumonitis with perilesional
edema.
 Pleural effusion.
 Hemothorax.
 Pneumothorax (rare).
Follow-up lung CT
performed 72 hours after
the incident, complete
recovery of the lung
parenchyma can be
observed.
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The mechanisms of the lesions are not clearly
understood but electrically-injured lung parenchyma
appears to develop coagulation necrosis.
The 3 major mechanisms of electricity-induced injury are:
 Electrical energy causing direct tissue damage, altering
cell membrane resting potential, and eliciting muscle
tetany.
 Conversion of electrical energy into thermal energy,
causing massive tissue destruction and coagulative
necrosis.
 Mechanical injury with direct trauma resulting from
falls or violent muscle contraction.
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Factors that determine the degree of injury include
the magnitude of energy delivered, resistance
encountered, type of current, current pathway, and
duration of contact. Systemic effects and tissue
damage are directly proportional to the magnitude
of current delivered to the victim
Electrical shock is classified as high voltage (>1000
volts) or low voltage (<1000 volts). As a general
rule, high voltage is associated with greater
morbidity and mortality, although fatal injury can
occur at household current (110 volts).
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The most common visceral lesions associated to
electric burns are cardiac lesions. Pulmonary
compromise is rare. Visceral complications
have a high mortality rate.
Although, when the beam goes through the
thorax , pleural effusion, hemotorax and
pneumonitis may occur.
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Chih-Cheng Lai a,b, Chih-Ming Lin c, Qi-Chang Xiao d, Liang-Wen Ding.
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