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Traumatic Nonpenetrating Lung Contusion

Traumatic Nonpenetrating Lung Contusion Traumatic Nonpenetrating Lung Contusion 1 Edward Stevens , M.D. and Arch W. Templeton , M.D. Department of Radiology University of Missouri Medical Center Columbia, Mo. Excerpt The response of lung to nonpenetrating blunt trauma of the magnitude that is often found in automotive accidents or falls has not been extensively studied. An evaluation and correlation of roentgenographic and clinical findings in 20 patients with traumatic nonpenetrating contusion of the lung form the basis of this report. In no case was there loss of skin integrity or rib fracture. The characteristic radiographic patterns and rate of resolution of the lung lesions are documented. Possible mechanisms of injury are discussed. Representative pathologic changes in three cases that came to autopsy are compared with the roentgenograms. Mechanisms of Injury The mechanisms of blast injury were investigated by Zuckerman (10) in 1941. In man, the positive pressure component of the blast wave acts as a direct force on the thoracic cage and causes injury to the underlying lung. These blast injuries vary clinically from cough in cases of lesser severity (2) to hemoptysis, chest pain, shock, and prostration (5). The most consistent physical findings are fullness of the lower chest and decreased breath sounds in the involved area. The roentgenographic findings also vary widely from scattered patchy infiltrates to generalized opacity of the lung fields. Not infrequently the x-ray findings are limited to a lobar distribution. Zuckerman described a characteristic appearance of crowding together of the ribs posteriorly and wide separation anteriorly and thought this due to hyperexpansion. Postmortem examination (4, 7, 11) demonstrates generalized arteriolar dilatation and intense focal capillary dilatation with exudation of fluid and erythrocytes into alveoli. In contradistinction to the findings in experimental animals (11), the alveoli in man tend to remain intact. Experimental direct trauma (with falling weights) to the lungs of dogs (1) produced hemorrhagic consolidation and frothy blood-tinged bronchial secretions. Microscopically, the alveoli were ruptured with extravasation of erythrocytes and edema fluid into air-containing spaces. The edema fluid was probably due to increased alveolar-capillary permeability secondary to the blocking of air passages by blood and resultant tissue anoxia. The irritating effect of dispersed blood on the pulmonary tissues enhanced the alveolar-capillary permeability. A reflex mechanism was also involved, however, as the edema could be partially prevented by the removal of sympathetic nervous system influence. The pathogenesis of the pulmonary changes produced in man secondary to direct blunt trauma can only be inferred from the animal experiments. Material and Results Twenty cases of pulmonary contusion were selected for evaluation. No fracture of the thoracic cage was identified on multiple clinical and roentgen examinations. Subsequent autopsy in 3 of the 20 patients also demonstrated an intact thoracic cage. The majority of patients (18) were injured in automobile accidents. The point of impact to the thoracic cage was seldom established by the history elicited from the patients; http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Traumatic Nonpenetrating Lung Contusion

Stevens, Edward; Templeton, Arch W.
Radiology , Volume 85 (2): 247 – Aug 1, 1965
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References (8)

Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1965 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/85.2.247
pmid
14323899
Publisher site
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Abstract

Traumatic Nonpenetrating Lung Contusion 1 Edward Stevens , M.D. and Arch W. Templeton , M.D. Department of Radiology University of Missouri Medical Center Columbia, Mo. Excerpt The response of lung to nonpenetrating blunt trauma of the magnitude that is often found in automotive accidents or falls has not been extensively studied. An evaluation and correlation of roentgenographic and clinical findings in 20 patients with traumatic nonpenetrating contusion of the lung form the basis of this report. In no case was there loss of skin integrity or rib fracture. The characteristic radiographic patterns and rate of resolution of the lung lesions are documented. Possible mechanisms of injury are discussed. Representative pathologic changes in three cases that came to autopsy are compared with the roentgenograms. Mechanisms of Injury The mechanisms of blast injury were investigated by Zuckerman (10) in 1941. In man, the positive pressure component of the blast wave acts as a direct force on the thoracic cage and causes injury to the underlying lung. These blast injuries vary clinically from cough in cases of lesser severity (2) to hemoptysis, chest pain, shock, and prostration (5). The most consistent physical findings are fullness of the lower chest and decreased breath sounds in the involved area. The roentgenographic findings also vary widely from scattered patchy infiltrates to generalized opacity of the lung fields. Not infrequently the x-ray findings are limited to a lobar distribution. Zuckerman described a characteristic appearance of crowding together of the ribs posteriorly and wide separation anteriorly and thought this due to hyperexpansion. Postmortem examination (4, 7, 11) demonstrates generalized arteriolar dilatation and intense focal capillary dilatation with exudation of fluid and erythrocytes into alveoli. In contradistinction to the findings in experimental animals (11), the alveoli in man tend to remain intact. Experimental direct trauma (with falling weights) to the lungs of dogs (1) produced hemorrhagic consolidation and frothy blood-tinged bronchial secretions. Microscopically, the alveoli were ruptured with extravasation of erythrocytes and edema fluid into air-containing spaces. The edema fluid was probably due to increased alveolar-capillary permeability secondary to the blocking of air passages by blood and resultant tissue anoxia. The irritating effect of dispersed blood on the pulmonary tissues enhanced the alveolar-capillary permeability. A reflex mechanism was also involved, however, as the edema could be partially prevented by the removal of sympathetic nervous system influence. The pathogenesis of the pulmonary changes produced in man secondary to direct blunt trauma can only be inferred from the animal experiments. Material and Results Twenty cases of pulmonary contusion were selected for evaluation. No fracture of the thoracic cage was identified on multiple clinical and roentgen examinations. Subsequent autopsy in 3 of the 20 patients also demonstrated an intact thoracic cage. The majority of patients (18) were injured in automobile accidents. The point of impact to the thoracic cage was seldom established by the history elicited from the patients;

Journal

Radiology – Radiological Society of North America, Inc.

Published: Aug 1, 1965

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