Chest injury

Chest injury is a serious injury of the chest. Chest injuries are a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury. Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths. The mortality rate is about 1600. Chest injuries were first described in detail in around 1600 BC in Ancient Egypt.

Classification

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

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

Specific types of injuries 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
  • Traumatic arrest
• 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.