PULMONARY LACERATION

PULMONARY LACERATION – Etiology, Classification, Pathophysiology, Diagnostic Evaluation and Management

  • Pulmonary laceration: in which lung tissue is torn or cut, differs from pulmonary contusion in that the former involves disruption of the macroscopic architecture of the lung
  • Pulmonary hematoma: when lacerations fill with blood, the result is pulmonary hematoma, a collection of blood within the lung tissue

ETIOLOGY

Pulmonary laceration is a common result of:

  • Penetrating trauma
  • Blunt trauma
  • Broken ribs
  • Shearing forces
  • Violent compression of the chest

CLASSIFICATION

  • Type I lacerations: which occur in the mid-lung area, the air-filled lung bursts as a result of sudden compression of the chest. Also called compression-rupture lacerations, type 1 are the most common type and usually occur in a central location of the lung. They tend to be large, ranging in size from 2 to 8 cm.
  • Type 2 lacerations: result when the lower chest is suddenly compressed and the lower lung is suddenly moved across the vertebral bodies. It is also called compression-shear, tends to occur near the spine and have an elongated shape. Type 2 lacerations usually occur in younger people with more flexible chests.
  • Type 3 lacerations: which are caused by punctures from fractured ribs, occur in the area near the chest wall underlying the broken rib. Also called rib penetration lacerations, type 3 lacerations tend to be small and accompanied by pneumothorax
  • Type 4 lacerations: also called adhesion tears, occur in cases where a pleuropulmonary adhesion had formed prior to the injury, in which the chest wall is suddenly fractured or pushed inward.

PATHOPHYSIOLOGY

Due to etiological factors (causes) —- a pulmonary laceration (causes) —- air to leak out of the lacerated lung and into the pleural space (results in) —- pneumothorax, hemothorax, hemopneumothorax

DIAGNOSTIC EVALUATION

  • X-ray: a chest X-ray of a right-sided pulmonary contusion associated with flail chest and subcutaneous emphysema. Contusion may mask pulmonary laceration on chest X-ray
  • CT scanning: on a CT scan, pulmonary lacerations show up in a contused area of the lung typically appearing as cavities filled with air or fluid that usually have a round or ovoid shape due to the lung’s elasticity
  • Thoracoscopy may be used in both diagnosis and treatment of pulmonary laceration

MANAGEMENT

  • As with other chest injuries, such as pulmonary contusion, hemothorax, and pneumothorax, pulmonary laceration can often be treated with just supplemental oxygen, ventilation, and drainage of fluids from the chest cavity
  • A thoracostomy tube can be used to remove blood and air from the chest cavity. About 5% of cases require surgery, called thoracotomy.

Surgical Treatment

  • Lobectomy: in which a lobe of the lung is removed
  • Pneumonectomy: in which an entire lung is removed

COMPLICATIONS

  • Pulmonary abscess
  • Bronchopleural fistula (a fistula between the pleural space and the bronchial tree)
  • Air embolism: in which air enters the bloodstream, is potentially fatal, especially when it occurs on the left side of the heart
PULMONARY LACERATION – Etiology, Classification, Pathophysiology, Diagnostic Evaluation and Management
PULMONARY LACERATION – Etiology, Classification, Pathophysiology, Diagnostic Evaluation and Management

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