1. Lung Trauma
Steven Podnos MD

2. Three Mechanisms of Injury
• Acceleration/Deceleration Shear on tissue
• Direct Impact
• Compression of lung against ribs/sternum
• RESULTS:
CONTUSION, LACERATION, HEMATOMA

3. Lung Contusion
• Lung Contusion
• Usually associated with other chest injuries
• A risk factor for ARDS and pneumonia
• May be insidious-usually seen on CXR within 6
hours after admit
• Local alveolar flooding and systemic effects

4. Lung Contusion with Rib Fracture

5. Lung Lacerations
• May be seen with both penetrating and with
blunt trauma
• May involve vessels and/or airways
• Pnemothorax/Hemothorax common
• CT scan and Bronchoscopy are diagnostic

6. Lung Laceration with Pneumothorax

7. Lung Contusion with SQE

8. Lung Hematoma
• May show up in first 72 hours
• Often resolves spontaneously

9. Flail Chest
• 3 or more ribs broken in two places
• Always have underlying lung contusion
• Mortality 10-20%
• Splint with positive pressure, consider plating

10. Flail Chest/Contusion

11. Complications and Management of
Lung Trauma
• Respiratory Failure, Pneumonia, ARDS are
primary complications
• Management is pain control-epidural, nerve
blocks, PCA anesthesia along with supportive
care (fluids and O2).
• Positive pressure ventilation for flail chest
• Chest tube
• May evolve rapidly