Chest trauma

Chest trauma
Classification and external resources
A CT scan of a pneumothorax
eMedicine	med/2916 med/3658
MeSH	D013898

Chest trauma (or thoracic trauma) is a serious injury of the chest. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury.^[1] Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths.^[1] The mortality rate is about 10%.^[2] Chest injuries were first described in detail in around 1600 BC in the ancient Egyptian Edwin Smith Papyrus.^[3]

Classification

A chest X-ray of a right sided pulmonary contusion associated with flail chest and subcutaneous emphysema

Chest trauma can be classified as blunt or penetrating. Blunt and penetrating injuries have different pathophysiologies and clinical courses.

Specific types of chest trauma include:

• Injuries to the chest wall
  • Chest wall contusions or hematomas.
  • Rib fractures
  • Flail chest
  • Sternal fractures
  • Fractures of the shoulder girdle
• Pulmonary injury (injury to the lung) and injuries involving the pleural space
  • Pulmonary contusion
  • Pulmonary laceration
  • Pneumothorax
  • Hemothorax
  • Hemopneumothorax
• Injury to the airways
  • Tracheobronchial tear
• Cardiac injury
  • Pericardial tamponade
  • Myocardial contusion
• Blood vessel injuries
  • Traumatic aortic rupture, thoracic aorta injury, aortic dissection
• And injuries to other structures within the torso
  • Esophageal injury (Boerhaave syndrome)
  • Diaphragm injury

Diagnosis

Most blunt injuries are managed with relatively simple interventions like tracheal intubation and mechanical ventilation and chest tube insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning. Penetrating injuries often require surgery, and complex investigations are usually not needed to come to a diagnosis. Patients with penetrating trauma may deteriorate rapidly, but may also recover much faster than patients with blunt injury.

References

1. ^ ^{a b} Keough V, Pudelek B (2001). "Blunt chest trauma: Review of selected pulmonary injuries focusing on pulmonary contusion". AACN Clinical Issues 12 (2): 270–281. doi:10.1097/00044067-200105000-00010. PMID 11759554. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1079-0713&volume=12&issue=2&spage=270. 
2. ^ Moloney JT, Fowler SJ, Chang W (February 2008). "Anesthetic management of thoracic trauma". Current Opinion in Anaesthesiology 21 (1): 41–46. doi:10.1097/ACO.0b013e3282f2aadc. PMID 18195608. 
3. ^ Miller DL, Mansour KA (2007). "Blunt traumatic lung injuries". Thoracic Surgery Clinics 17 (1): 57–61. doi:10.1016/j.thorsurg.2007.03.017. PMID 17650697. 

External links

• Trauma.org: thoracic trauma