Lung trauma can occur through three mechanisms: acceleration/deceleration shear forces, direct impact, or compression against the chest. This can result in contusions, lacerations, or hematomas visible on CT or chest x-rays. Complications include respiratory failure, pneumonia, and ARDS. Management involves pain control, supportive care like oxygen supplementation, positive pressure ventilation for flail chest injuries, and chest tubes. Conditions like contusions, lacerations, and flail chest often have underlying lung injuries and can rapidly deteriorate.

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