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Pulmonary laceration

Case contributed by James Sheldon
Diagnosis certain

Presentation

High speed motorbike accident

Patient Data

Age: 20 years
Gender: Male
ct

Extensive pulmonary contusions demonstrated within the left lower lobe and the lingular segment of the left upper lobe. There are areas of pulmonary hemorrhage and haemato-pneumatocele formation suggesting pulmonary laceration. Small left pneumothorax.

Subtle regions of ground glass opacity in the right lower lobe probably represent small pulmonary contusions. Tiny left pneumothorax. No evidence of traumatic aortic injury. No mediastinal hematoma.

There are non displaced rib fractures involving the lateral 5th-9th ribs on the left and the left 9th posterior rib (these were best appreciated on bone windows). No scapular, clavicular (incomplete views) or sternal fracture is identified. Unfused sternal body noted.

Case Discussion

A pulmonary laceration results from frank laceration of lung parenchyma secondary to trauma. There is almost always concurrent contusion.

Classification

  • type I - compression rupture
  • type II - compression shear
  • type III - direct puncture / rib penetration
  • type IV - adhesion tears

CT usually demonstates regions of pulmonary contusion with added blebs (pneumatocoeles or haemato pneumatoceles) with air fluid levels.  

Due to normal pulmonary elastic recoil, lung tissues surrounding a laceration often pull back from the laceration itself. This results in the laceration manifesting at CT as a round or oval cavity, instead of having the linear appearance typically seen in other solid organs.

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