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Pulmonary Contusion/Laceration
Terrance Healey, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Injury to lung parenchyma secondary to blunt or penetrating trauma
                • Typically a combination of contusion, hemorrhage, and laceration
                • Contusion: Torn capillaries and small blood vessels without frank disruption of alveoli
                  • Marker of severe kinetic energy absorption; not simply a "lung bruise"
                • Laceration: Disruption of alveoli leading to radial parenchymal retraction
                  • Blunt trauma: Linear tear produces spherical hole in lung parenchyma
                  • Penetrating trauma: Laceration conforms to path of penetrating object, commonly bullet and knife
                  • Typically filled with variable amounts of air and blood
                    • Pulmonary hematoma: Blood-filled laceration
                    • Pneumatocele: Air-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. Mirka H et al: Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging. 3(5):433-49, 2012
                                              2. Oikonomou A et al: CT imaging of blunt chest trauma. Insights Imaging. 2(3):281-295, 2011
                                              3. Ahmed N et al: Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 76(11):1236-9, 2010
                                              4. de Vries CS et al: The imaging of stab injuries. Acta Radiol. 51(1):92-106, 2010
                                              5. 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
                                              6. Kaewlai R et al: Multidetector CT of blunt thoracic trauma. Radiographics. 28(6):1555-70, 2008
                                              7. 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
                                              8. Mirvis SE: Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR. 25(2):156-79, 2004
                                              9. Mullinix AJ et al: Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 28 Suppl 1:S20-7, 2004
                                              10. Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
                                              11. 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
                                              12. Ketai L et al: Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging. 15(2):120-7, 2000
                                              13. LeBlang SD et al: Imaging of penetrating thoracic trauma. J Thorac Imaging. 15(2):128-35, 2000
                                              14. Mirvis SE et al: MR imaging of thoracic trauma. Magn Reson Imaging Clin N Am. 8(1):91-104, 2000
                                              15. Wicky S et al: Imaging of blunt chest trauma. Eur Radiol. 10(10):1524-38, 2000
                                              16. Zinck SE et al: Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 15(2):87-96, 2000
                                              17. Shanmuganathan K et al: Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 37(3):533-51, vi, 1999
                                              18. 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
                                              19. Van Hise ML et al: CT in blunt chest trauma: indications and limitations. Radiographics. 18(5):1071-84, 1998
                                              20. Kang EY et al: CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 17(2):114-8, 1996
                                              21. Reuter M: Trauma of the chest. Eur Radiol. 6(5):707-16, 1996
                                              22. Mirvis SE et al: Imaging in acute thoracic trauma. Semin Roentgenol. 27(3):184-210, 1992
                                              23. 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

                                                          • Definitions

                                                            • Injury to lung parenchyma secondary to blunt or penetrating trauma
                                                            • Typically a combination of contusion, hemorrhage, and laceration
                                                            • Contusion: Torn capillaries and small blood vessels without frank disruption of alveoli
                                                              • Marker of severe kinetic energy absorption; not simply a "lung bruise"
                                                            • Laceration: Disruption of alveoli leading to radial parenchymal retraction
                                                              • Blunt trauma: Linear tear produces spherical hole in lung parenchyma
                                                              • Penetrating trauma: Laceration conforms to path of penetrating object, commonly bullet and knife
                                                              • Typically filled with variable amounts of air and blood
                                                                • Pulmonary hematoma: Blood-filled laceration
                                                                • Pneumatocele: Air-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. Mirka H et al: Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging. 3(5):433-49, 2012
                                                                                          2. Oikonomou A et al: CT imaging of blunt chest trauma. Insights Imaging. 2(3):281-295, 2011
                                                                                          3. Ahmed N et al: Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 76(11):1236-9, 2010
                                                                                          4. de Vries CS et al: The imaging of stab injuries. Acta Radiol. 51(1):92-106, 2010
                                                                                          5. 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
                                                                                          6. Kaewlai R et al: Multidetector CT of blunt thoracic trauma. Radiographics. 28(6):1555-70, 2008
                                                                                          7. 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
                                                                                          8. Mirvis SE: Diagnostic imaging of acute thoracic injury. Semin Ultrasound CT MR. 25(2):156-79, 2004
                                                                                          9. Mullinix AJ et al: Multidetector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 28 Suppl 1:S20-7, 2004
                                                                                          10. Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 25(2):180-204, 2004
                                                                                          11. 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
                                                                                          12. Ketai L et al: Nonaortic mediastinal injuries from blunt chest trauma. J Thorac Imaging. 15(2):120-7, 2000
                                                                                          13. LeBlang SD et al: Imaging of penetrating thoracic trauma. J Thorac Imaging. 15(2):128-35, 2000
                                                                                          14. Mirvis SE et al: MR imaging of thoracic trauma. Magn Reson Imaging Clin N Am. 8(1):91-104, 2000
                                                                                          15. Wicky S et al: Imaging of blunt chest trauma. Eur Radiol. 10(10):1524-38, 2000
                                                                                          16. Zinck SE et al: Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 15(2):87-96, 2000
                                                                                          17. Shanmuganathan K et al: Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 37(3):533-51, vi, 1999
                                                                                          18. 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
                                                                                          19. Van Hise ML et al: CT in blunt chest trauma: indications and limitations. Radiographics. 18(5):1071-84, 1998
                                                                                          20. Kang EY et al: CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 17(2):114-8, 1996
                                                                                          21. Reuter M: Trauma of the chest. Eur Radiol. 6(5):707-16, 1996
                                                                                          22. Mirvis SE et al: Imaging in acute thoracic trauma. Semin Roentgenol. 27(3):184-210, 1992
                                                                                          23. Wagner RB et al: Classification of parenchymal injuries of the lung. Radiology. 167(1):77-82, 1988