Lung injury secondary to blunt or penetrating trauma
Often hemorrhage + contusion + laceration
Blast injuries: High-energy forces after explosion
Spallation: Bursting phenomenon when pressure waves deposit energy at alveolar liquid-gas interfaces
Contusion: Alveolar hemorrhage without disruption of alveolar architecture
Marker of severe kinetic energy absorption; not simply "lung bruise"
Laceration: Alveolar disruption resulting in parenchymal retraction
Blunt trauma or blast injury: Linear tear produces ovoid lung defect
Penetrating trauma: Laceration conforms to path of penetrating object, commonly bullets and knives
Defect fills with variable amounts of air ± blood
Pneumatocele: Air-filled laceration
Parenchymal hematoma: Blood-filled laceration
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Bagga B et al: Traumatic airway injuries: role of imaging. Curr Probl Diagn Radiol. 49(1):48-53, 2020
Lichtenberger JP et al: Imaging of combat-related thoracic trauma - review of penetrating trauma. Mil Med. 183(3-4):e81-8, 2018
Lichtenberger JP et al: Imaging of combat-related thoracic trauma - blunt trauma and blast lung injury. Mil Med. 183(3-4):e89-96, 2018
Požgain Z et al: Pulmonary contusions after blunt chest trauma: clinical significance and evaluation of patient management. Eur J Trauma Emerg Surg. 44(5):773-7, 2018
Dennis BM et al: Thoracic trauma. Surg Clin North Am. 97(5):1047-64, 2017
Moon SH et al: The thorax trauma severity score and the trauma and injury severity score: do they predict in-hospital mortality in patients with severe thoracic trauma?: A retrospective cohort study. Medicine (Baltimore). 96(42):e8317, 2017
Daurat A et al: Thoracic trauma severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 47(1):147-53, 2016
Zeidenberg J et al: Imaging of penetrating torso trauma. Semin Roentgenol. 51(3):239-55, 2016
Durso AM et al: Penetrating thoracic injury. Radiol Clin North Am. 53(4):675-93, vii-viii, 2015
Ahmed N et al: Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 76(11):1236-9, 2010
Nishiumi N et al: Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma. Ann Thorac Surg. 89(1):232-8, 2010
Kaewlai R et al: Multidetector CT of blunt thoracic trauma. Radiographics. 28(6):1555-70, 2008
Sangster GP et al: Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol. 14(5):297-310, 2007
Mirvis SE: Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR. 25(2):156-79, 2004
Mullinix AJ et al: Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 28 Suppl 1:S20-7, 2004
Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
Miller PR et al: ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma. 51(2):223-8; discussion 229-30, 2001
Ketai L et al: Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging. 15(2):120-7, 2000
LeBlang SD et al: Imaging of penetrating thoracic trauma. J Thorac Imaging. 15(2):128-35, 2000
Mirvis SE et al: MR imaging of thoracic trauma. Magn Reson Imaging Clin N Am. 8(1):91-104, 2000
Wicky S et al: Imaging of blunt chest trauma. Eur Radiol. 10(10):1524-38, 2000
Zinck SE et al: Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 15(2):87-96, 2000
Shanmuganathan K et al: Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 37(3):533-51, vi, 1999
Kuhlman JE et al: Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them. Radiographics. 18(5):1085-106; discussion 1107-8; quiz 1, 1998
Van Hise ML et al: CT in blunt chest trauma: indications and limitations. Radiographics. 18(5):1071-84, 1998
Kang EY et al: CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 17(2):114-8, 1996
Reuter M: Trauma of the chest. Eur Radiol. 6(5):707-16, 1996
Mirvis SE et al: Imaging in acute thoracic trauma. Semin Roentgenol. 27(3):184-210, 1992
Wagner RB et al: Classification of parenchymal injuries of the lung. Radiology. 167(1):77-82, 1988
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Acute respiratory distress syndrome (ARDS)
Definitions
Lung injury secondary to blunt or penetrating trauma
Often hemorrhage + contusion + laceration
Blast injuries: High-energy forces after explosion
Spallation: Bursting phenomenon when pressure waves deposit energy at alveolar liquid-gas interfaces
Contusion: Alveolar hemorrhage without disruption of alveolar architecture
Marker of severe kinetic energy absorption; not simply "lung bruise"
Laceration: Alveolar disruption resulting in parenchymal retraction
Blunt trauma or blast injury: Linear tear produces ovoid lung defect
Penetrating trauma: Laceration conforms to path of penetrating object, commonly bullets and knives
Defect fills with variable amounts of air ± blood
Pneumatocele: Air-filled laceration
Parenchymal hematoma: Blood-filled laceration
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Bagga B et al: Traumatic airway injuries: role of imaging. Curr Probl Diagn Radiol. 49(1):48-53, 2020
Lichtenberger JP et al: Imaging of combat-related thoracic trauma - review of penetrating trauma. Mil Med. 183(3-4):e81-8, 2018
Lichtenberger JP et al: Imaging of combat-related thoracic trauma - blunt trauma and blast lung injury. Mil Med. 183(3-4):e89-96, 2018
Požgain Z et al: Pulmonary contusions after blunt chest trauma: clinical significance and evaluation of patient management. Eur J Trauma Emerg Surg. 44(5):773-7, 2018
Dennis BM et al: Thoracic trauma. Surg Clin North Am. 97(5):1047-64, 2017
Moon SH et al: The thorax trauma severity score and the trauma and injury severity score: do they predict in-hospital mortality in patients with severe thoracic trauma?: A retrospective cohort study. Medicine (Baltimore). 96(42):e8317, 2017
Daurat A et al: Thoracic trauma severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 47(1):147-53, 2016
Zeidenberg J et al: Imaging of penetrating torso trauma. Semin Roentgenol. 51(3):239-55, 2016
Durso AM et al: Penetrating thoracic injury. Radiol Clin North Am. 53(4):675-93, vii-viii, 2015
Ahmed N et al: Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 76(11):1236-9, 2010
Nishiumi N et al: Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma. Ann Thorac Surg. 89(1):232-8, 2010
Kaewlai R et al: Multidetector CT of blunt thoracic trauma. Radiographics. 28(6):1555-70, 2008
Sangster GP et al: Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol. 14(5):297-310, 2007
Mirvis SE: Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR. 25(2):156-79, 2004
Mullinix AJ et al: Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 28 Suppl 1:S20-7, 2004
Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
Miller PR et al: ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma. 51(2):223-8; discussion 229-30, 2001
Ketai L et al: Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging. 15(2):120-7, 2000
LeBlang SD et al: Imaging of penetrating thoracic trauma. J Thorac Imaging. 15(2):128-35, 2000
Mirvis SE et al: MR imaging of thoracic trauma. Magn Reson Imaging Clin N Am. 8(1):91-104, 2000
Wicky S et al: Imaging of blunt chest trauma. Eur Radiol. 10(10):1524-38, 2000
Zinck SE et al: Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 15(2):87-96, 2000
Shanmuganathan K et al: Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 37(3):533-51, vi, 1999
Kuhlman JE et al: Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them. Radiographics. 18(5):1085-106; discussion 1107-8; quiz 1, 1998
Van Hise ML et al: CT in blunt chest trauma: indications and limitations. Radiographics. 18(5):1071-84, 1998
Kang EY et al: CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 17(2):114-8, 1996
Reuter M: Trauma of the chest. Eur Radiol. 6(5):707-16, 1996
Mirvis SE et al: Imaging in acute thoracic trauma. Semin Roentgenol. 27(3):184-210, 1992
Wagner RB et al: Classification of parenchymal injuries of the lung. Radiology. 167(1):77-82, 1988
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