Presentation
Blunt chest trauma
Patient Data
Large hazy left mid zone opacity containing a cavity.
Smaller medial left basal cavity and adjacent opacity.
Small left pneumothorax.
Large ill-defined ground-glass opacity in the left upper lobe containing central hemo-pneumatocoele and numerous small cavities. Small fistula through visceral pleura and small hemopneumothorax.
Smaller left lower lobe paraspinal ground-glass opacity with central cavity.
Small pneumomediastinum. Gas in abnormal locations is more obvious on MinIPs.
Fractures of the left 2nd and third ribs with anterior deformity and fracture clavicular shaft.
Two expanding left lung cavities.
Opacities partially cleared.
Expanding dominant thick-walled left lung cavity with irregular inner margin. Many of the smaller cavities are partially or fully resolved. Partial clearing of the surrounding opacity.
New small opacities in the right posterior costophrenic recess and left basal atelectasis.
Small pleural collections, larger on the left.
Pneumothorax and pneumomediastinum resolved.
Focal scars mark the location of lung injury.
Case Discussion
The pattern of injuries indicates severe blunt chest trauma with compression-rupture injury to the left upper lobe and compression-shear injury to the paraspinal left lower lobe. The small bronchopleural fistula suggests penetration injury from a displaced rib fracture. (Maximum displacement occurs at the time of the injury.) The delayed right basal opacities may indicate contre-coup contusions.
Contusion conspicuity peaks at 48-72 hours. The opacity is due to blood and edema in intact lung and can resolve within 2 weeks.
Lacerations typically resolve over weeks or months leaving scars. In this case, the larger left upper lobe laceration was incompletely healed after 2 months.
Blunt lung injuries reflect the degree of deformation of the chest wall. Tears expand due to elastic recoil of the adjacent lung, forming rounded cavities. In this case the cavities filled with gas and blood, forming haematopneumatocoeles.
NB. Check for major airway or vascular injury and bronchopleural fistula.
Potential complications include respiratory failure, ARDS, pneumonia, abscess, arteriovenous fistula and pseudoaneurym.