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Lung Trauma
Allen Heeger, DO
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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

                                              1. Bagga B et al: Traumatic airway injuries: role of imaging. Curr Probl Diagn Radiol. 49(1):48-53, 2020
                                              2. Lichtenberger JP et al: Imaging of combat-related thoracic trauma - review of penetrating trauma. Mil Med. 183(3-4):e81-8, 2018
                                              3. Lichtenberger JP et al: Imaging of combat-related thoracic trauma - blunt trauma and blast lung injury. Mil Med. 183(3-4):e89-96, 2018
                                              4. 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
                                              5. Dennis BM et al: Thoracic trauma. Surg Clin North Am. 97(5):1047-64, 2017
                                              6. 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
                                              7. 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
                                              8. Zeidenberg J et al: Imaging of penetrating torso trauma. Semin Roentgenol. 51(3):239-55, 2016
                                              9. Durso AM et al: Penetrating thoracic injury. Radiol Clin North Am. 53(4):675-93, vii-viii, 2015
                                              10. Ahmed N et al: Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 76(11):1236-9, 2010
                                              11. 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
                                              12. Kaewlai R et al: Multidetector CT of blunt thoracic trauma. Radiographics. 28(6):1555-70, 2008
                                              13. 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
                                              14. Mirvis SE: Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR. 25(2):156-79, 2004
                                              15. Mullinix AJ et al: Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 28 Suppl 1:S20-7, 2004
                                              16. Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
                                              17. 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
                                              18. Ketai L et al: Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging. 15(2):120-7, 2000
                                              19. LeBlang SD et al: Imaging of penetrating thoracic trauma. J Thorac Imaging. 15(2):128-35, 2000
                                              20. Mirvis SE et al: MR imaging of thoracic trauma. Magn Reson Imaging Clin N Am. 8(1):91-104, 2000
                                              21. Wicky S et al: Imaging of blunt chest trauma. Eur Radiol. 10(10):1524-38, 2000
                                              22. Zinck SE et al: Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 15(2):87-96, 2000
                                              23. Shanmuganathan K et al: Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 37(3):533-51, vi, 1999
                                              24. 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
                                              25. Van Hise ML et al: CT in blunt chest trauma: indications and limitations. Radiographics. 18(5):1071-84, 1998
                                              26. Kang EY et al: CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 17(2):114-8, 1996
                                              27. Reuter M: Trauma of the chest. Eur Radiol. 6(5):707-16, 1996
                                              28. Mirvis SE et al: Imaging in acute thoracic trauma. Semin Roentgenol. 27(3):184-210, 1992
                                              29. 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

                                                                                          1. Bagga B et al: Traumatic airway injuries: role of imaging. Curr Probl Diagn Radiol. 49(1):48-53, 2020
                                                                                          2. Lichtenberger JP et al: Imaging of combat-related thoracic trauma - review of penetrating trauma. Mil Med. 183(3-4):e81-8, 2018
                                                                                          3. Lichtenberger JP et al: Imaging of combat-related thoracic trauma - blunt trauma and blast lung injury. Mil Med. 183(3-4):e89-96, 2018
                                                                                          4. 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
                                                                                          5. Dennis BM et al: Thoracic trauma. Surg Clin North Am. 97(5):1047-64, 2017
                                                                                          6. 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
                                                                                          7. 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
                                                                                          8. Zeidenberg J et al: Imaging of penetrating torso trauma. Semin Roentgenol. 51(3):239-55, 2016
                                                                                          9. Durso AM et al: Penetrating thoracic injury. Radiol Clin North Am. 53(4):675-93, vii-viii, 2015
                                                                                          10. Ahmed N et al: Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 76(11):1236-9, 2010
                                                                                          11. 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
                                                                                          12. Kaewlai R et al: Multidetector CT of blunt thoracic trauma. Radiographics. 28(6):1555-70, 2008
                                                                                          13. 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
                                                                                          14. Mirvis SE: Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR. 25(2):156-79, 2004
                                                                                          15. Mullinix AJ et al: Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 28 Suppl 1:S20-7, 2004
                                                                                          16. Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
                                                                                          17. 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
                                                                                          18. Ketai L et al: Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging. 15(2):120-7, 2000
                                                                                          19. LeBlang SD et al: Imaging of penetrating thoracic trauma. J Thorac Imaging. 15(2):128-35, 2000
                                                                                          20. Mirvis SE et al: MR imaging of thoracic trauma. Magn Reson Imaging Clin N Am. 8(1):91-104, 2000
                                                                                          21. Wicky S et al: Imaging of blunt chest trauma. Eur Radiol. 10(10):1524-38, 2000
                                                                                          22. Zinck SE et al: Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 15(2):87-96, 2000
                                                                                          23. Shanmuganathan K et al: Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 37(3):533-51, vi, 1999
                                                                                          24. 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
                                                                                          25. Van Hise ML et al: CT in blunt chest trauma: indications and limitations. Radiographics. 18(5):1071-84, 1998
                                                                                          26. Kang EY et al: CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 17(2):114-8, 1996
                                                                                          27. Reuter M: Trauma of the chest. Eur Radiol. 6(5):707-16, 1996
                                                                                          28. Mirvis SE et al: Imaging in acute thoracic trauma. Semin Roentgenol. 27(3):184-210, 1992
                                                                                          29. Wagner RB et al: Classification of parenchymal injuries of the lung. Radiology. 167(1):77-82, 1988