Lung injuries can manifest as lung laceration, pulmonary contusion, or blast injury depending on the cause and characteristics of the trauma. Lung laceration accompanied by visceral pleural rupture may result in hemopneumothorax, while an intact visceral pleura often leads to the formation of an intrapulmonary hematoma. Pulmonary contusions are primarily caused by blunt trauma. Following injury, an inflammatory response leads to increased capillary permeability, infiltration of inflammatory cells, and the release of inflammatory mediators. These changes result in edema in the injured area, and extensive pulmonary interstitial and alveolar edema can cause ventilation impairment and hypoxemia. Blast injuries to the lungs are caused by high-pressure air or water waves generated by explosions that damage lung tissue.
The diagnosis and management of hemopneumothorax caused by lung laceration has been described previously. Intrapulmonary hematomas are often identified during chest X-ray examinations as well-defined, round or oval masses with increased density within the lung and typically resolve spontaneously within two weeks to several months. Patients with pulmonary contusions may present with dyspnea, hemoptysis, bloody frothy sputum, and lung rales. Severe cases may develop hypoxemia and are often accompanied by flail chest. Chest X-rays reveal patchy opacities, which generally become more pronounced 24–48 hours after the injury. A CT scan is more accurate than a conventional chest X-ray in assessing the extent and severity of pulmonary contusions.
Principles of Management
Appropriate treatment of associated injuries is critical.
Ensuring airway patency is essential.
Oxygen therapy is provided.
Excessive infusion of crystalloid fluids is avoided.
Early and rational use of glucocorticoids is considered.
Mechanical ventilation is applied for cases of hypoxemia.
For severe penetrating lung injuries, gunshot wounds, or similar trauma, patients may experience massive intratracheal bleeding, shock, and life-threatening complications, necessitating emergency thoracotomy. In such cases, surgical resection of the injured lung may also be required.
Preventing and managing infections is a key component of care.