Blunt chest trauma is a non-penetrating traumatic injury to the thoracic cavity. Thoracic traumatic injuries are classified according to the mechanism of injury as blunt or penetrating injuries Penetrating injuries Wounds caused by objects penetrating the skin. Genitourinary Trauma. Different structures can be injured including the chest wall Chest wall The chest wall consists of skin, fat, muscles, bones, and cartilage. The bony structure of the chest wall is composed of the ribs, sternum, and thoracic vertebrae. The chest wall serves as armor for the vital intrathoracic organs and provides the stability necessary for the movement of the shoulders and arms. Chest Wall: Anatomy ( ribs Ribs A set of twelve curved bones which connect to the vertebral column posteriorly, and terminate anteriorly as costal cartilage. Together, they form a protective cage around the internal thoracic organs. Chest Wall: Anatomy, sternum Sternum A long, narrow, and flat bone commonly known as breastbone occurring in the midsection of the anterior thoracic segment or chest region, which stabilizes the rib cage and serves as the point of origin for several muscles that move the arms, head, and neck. Chest Wall: Anatomy), lungs Lungs Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2. Lungs: Anatomy, heart, major blood vessels, and the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy. The extent and specific type of thoracic traumatic injury can be identified by a proper history and physical examination supported by adequate imaging studies. Management depends on the specific type of injury.
Last updated: 9 Mar, 2021
Blunt chest trauma is injury and consequential pathology arising from application of significant kinetic forces to the chest that do not cause penetration Penetration X-rays of the thoracic cavity.
The chest wall Chest wall The chest wall consists of skin, fat, muscles, bones, and cartilage. The bony structure of the chest wall is composed of the ribs, sternum, and thoracic vertebrae. The chest wall serves as armor for the vital intrathoracic organs and provides the stability necessary for the movement of the shoulders and arms. Chest Wall: Anatomy is composed of:
The chest wall Chest wall The chest wall consists of skin, fat, muscles, bones, and cartilage. The bony structure of the chest wall is composed of the ribs, sternum, and thoracic vertebrae. The chest wall serves as armor for the vital intrathoracic organs and provides the stability necessary for the movement of the shoulders and arms. Chest Wall: Anatomy‘s function is to absorb trauma and protect underlying vulnerable structures from damage:
The suspected mechanism of injury should prompt suspicion for blunt chest trauma. Treatment algorithms and guidelines direct evaluation:
While the initial approach to stabilizing a patient with chest trauma is standardized, further imaging and testing is dependent on the injury discovered during the initial assessment.
Choosing the best imaging studies depends on the patient’s hemodynamic stability:
Flail chest Flail chest Flail chest is a life-threatening traumatic injury that occurs when 3 or more contiguous ribs are fractured in 2 or more different locations. Patients present with chest pain, tachypnea, hypoxia, and paradoxical chest wall movement. Flail Chest: fractured ribs Ribs A set of twelve curved bones which connect to the vertebral column posteriorly, and terminate anteriorly as costal cartilage. Together, they form a protective cage around the internal thoracic organs. Chest Wall: Anatomy that move paradoxically in comparison to the chest wall Chest wall The chest wall consists of skin, fat, muscles, bones, and cartilage. The bony structure of the chest wall is composed of the ribs, sternum, and thoracic vertebrae. The chest wall serves as armor for the vital intrathoracic organs and provides the stability necessary for the movement of the shoulders and arms. Chest Wall: Anatomy
Image by Lecturio.Chest CT showing comminuted sternal
fracture
Fracture
A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma.
Overview of Bone Fractures:
Fractures of the
sternum
Sternum
A long, narrow, and flat bone commonly known as breastbone occurring in the midsection of the anterior thoracic segment or chest region, which stabilizes the rib cage and serves as the point of origin for several muscles that move the arms, head, and neck.
Chest Wall: Anatomy can occur during high-energy chest traumas and can be simple (meaning a single
fracture
Fracture
A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma.
Overview of Bone Fractures) or comminuted (where the
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types breaks into multiple fragments). Usually, fractures of the
sternum
Sternum
A long, narrow, and flat bone commonly known as breastbone occurring in the midsection of the anterior thoracic segment or chest region, which stabilizes the rib cage and serves as the point of origin for several muscles that move the arms, head, and neck.
Chest Wall: Anatomy are associated with underlying injury of the
lungs
Lungs
Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2.
Lungs: Anatomy or heart.
Chest radiograph demonstrating a left
pneumothorax
Pneumothorax
A pneumothorax is a life-threatening condition in which air collects in the pleural space, causing partial or full collapse of the lung. A pneumothorax can be traumatic or spontaneous. Patients present with a sudden onset of sharp chest pain, dyspnea, and diminished breath sounds on exam.
Pneumothorax:
The green line outlines the pleural line. Notice the lack of bronchovascular markings beyond that line.
AP chest X-ray Chest X-ray X-ray visualization of the chest and organs of the thoracic cavity. It is not restricted to visualization of the lungs. Pulmonary Function Tests revealing evidence of bilateral lung contusions and left subcutaneous emphysema Subcutaneous emphysema Presence of air or gas in the subcutaneous tissues of the body. Mallory-Weiss Syndrome (Mallory-Weiss Tear) (Panel A): Chest CT confirmed both the lung contusions and the subcutaneous emphysema Subcutaneous emphysema Presence of air or gas in the subcutaneous tissues of the body. Mallory-Weiss Syndrome (Mallory-Weiss Tear) and demonstrated a left sided pneumothorax Pneumothorax A pneumothorax is a life-threatening condition in which air collects in the pleural space, causing partial or full collapse of the lung. A pneumothorax can be traumatic or spontaneous. Patients present with a sudden onset of sharp chest pain, dyspnea, and diminished breath sounds on exam. Pneumothorax not initially appearing on the anteroposterior chest X-ray Chest X-ray X-ray visualization of the chest and organs of the thoracic cavity. It is not restricted to visualization of the lungs. Pulmonary Function Tests (Panel B).
Image: “Bilateral lung contusions” by Departement of Internal Medicine, Mercy Hospital and Medical Center, Chicago, Illinois, USA. License: CC BY 2.0
Tension pneumothorax
Tension Pneumothorax
Pneumothorax:
Spontaneous and traumatic pneumothoraces can develop into a
tension pneumothorax
Tension Pneumothorax
Pneumothorax if the defect that allows air into the
pleural space
Pleural space
The thin serous membrane enveloping the lungs (lung) and lining the thoracic cavity. Pleura consist of two layers, the inner visceral pleura lying next to the pulmonary parenchyma and the outer parietal pleura. Between the two layers is the pleural cavity which contains a thin film of liquid.
Pleuritis becomes a 1-way valve (air enters during
inspiration
Inspiration
Ventilation: Mechanics of Breathing, but cannot
escape
Escape
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Cancer Immunotherapy during
expiration
Expiration
Ventilation: Mechanics of Breathing), which causes rising pressure in the
pleural cavity
Pleural cavity
Paired but separate cavity within the thoracic cavity. It consists of the space between the parietal and visceral pleura and normally contains a capillary layer of serous fluid that lubricates the pleural surfaces.
Pleura: Anatomy, shifting the
mediastinum
Mediastinum
The mediastinum is the thoracic area between the 2 pleural cavities. The mediastinum contains vital structures of the circulatory, respiratory, digestive, and nervous systems including the heart and esophagus, and major thoracic vessels.
Mediastinum and Great Vessels: Anatomy to the contralateral side.
Commotio cordis risk window:
Commotio cordis is a
cardiac
Cardiac
Total Anomalous Pulmonary Venous Return (TAPVR) arrest that occurs when the chest over the heart is struck during the portion of the
cardiac
Cardiac
Total Anomalous Pulmonary Venous Return (TAPVR)
cycle
Cycle
The type of signal that ends the inspiratory phase delivered by the ventilator
Invasive Mechanical Ventilation corresponding with the upstroke of the
T wave
T wave
Electrocardiogram (ECG) on
ECG
ECG
An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures.
Electrocardiogram (ECG).
Diaphragmatic rupture:
Rupture of the
diaphragm
Diaphragm
The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force.
Diaphragm: Anatomy secondary to chest trauma seen on
chest X-ray
Chest X-ray
X-ray visualization of the chest and organs of the thoracic cavity. It is not restricted to visualization of the lungs.
Pulmonary Function Tests as bowel contents in the thoracic cavity. Arrow labeled X points to portion of the
spleen
Spleen
The spleen is the largest lymphoid organ in the body, located in the LUQ of the abdomen, superior to the left kidney and posterior to the stomach at the level of the 9th-11th ribs just below the diaphragm. The spleen is highly vascular and acts as an important blood filter, cleansing the blood of pathogens and damaged erythrocytes.
Spleen: Anatomy herniating into the chest cavity through a diaphragmatic rupture.