A chest injury, also known as chest trauma, is any form of physical
injury
Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants.
Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...
to the
chest
The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen.
In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main di ...
including the
ribs
The rib cage or thoracic cage is an endoskeletal enclosure in the thorax of most vertebrates that comprises the ribs, vertebral column and sternum, which protect the vital organs of the thoracic cavity, such as the heart, lungs and great vessels ...
,
heart
The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...
and
lungs
The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syste ...
. Chest injuries account for 25% of all deaths from traumatic injury. Typically chest injuries are caused by blunt mechanisms such as direct, indirect, compression, contusion, deceleration, or blasts caused by
motor vehicle collisions
A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tr ...
or penetrating mechanisms such as
stabbings.
Classification
Chest injuries can be classified as
blunt
Blunt may refer to:
* Blunt (surname), a surname (and list of people with the name)
* Blunt (cigar), a term used in the cigar industry to designate blunt-tipped, usually factory-rolled cigars
* Blunt (cannabis), a slang term used in cannabis cult ...
or
penetrating. Blunt and penetrating injuries have different
pathophysiologies and clinical courses.
Specific types of injuries include:
* Injuries to the
chest wall
The thoracic wall or chest wall is the boundary of the thoracic cavity.
Structure
The bony skeletal part of the thoracic wall is the rib cage, and the rest is made up of muscle, skin, and fasciae.
The chest wall has 10 layers, namely (from ...
** Chest wall
contusion
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clo ...
s or
hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...
s
**
Rib fracture
A rib fracture is a break in a rib bone. This typically results in chest pain that is worse with inspiration. Bruising may occur at the site of the break. When several ribs are broken in several places a flail chest results. Potential complicat ...
s
**
Flail chest
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath. ...
**
Sternal fracture
A sternal fracture is a bone fracture, fracture of the Human sternum, sternum (the breastbone), located in the center of the chest. The injury, which occurs in 5–8% of people who experience significant blunt chest trauma, may occur in vehicle a ...
s
**
Fracture
Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...
s of the
shoulder girdle
The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans, it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists o ...
* Pulmonary injury (injury to the lung) and injuries involving the
pleural space
The pleural cavity, or pleural space (or sometimes intrapleural space), is the potential space between the pulmonary pleurae, pleurae of the pleural sac that surrounds each lung. A small amount of serous fluid, serous pleural fluid is maintained ...
**
Pulmonary contusion
A pulmonary contusion, also known as a lung contusion, is a bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, ...
**
Pulmonary laceration
A pulmonary laceration is a chest injury in which lung tissue is torn or cut.
An injury that is potentially more serious than pulmonary contusion, pulmonary laceration involves disruption of the architecture of the lung,
while pulmonary contus ...
**
Pneumothorax
A pneumothorax is collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and dyspnea, shortness of breath. In a minority of cases, a one-way valve is ...
**
Hemothorax
A hemothorax (derived from hemo- lood+ thorax hest plural ''hemothoraces'') is an accumulation of blood within the pleural cavity. The symptoms of a hemothorax may include chest pain and difficulty breathing, while the clinical signs may inc ...
**
Hemopneumothorax
* Injury to the airways
**
Tracheobronchial tear
* Cardiac injury
**
Pericardial tamponade
Cardiac tamponade, also known as pericardial tamponade (), is a compression of the heart due to pericardial effusion (the build-up of pericardial fluid in the sac around the heart). Onset may be rapid or gradual. Symptoms typically include those ...
**
Myocardial contusion
A blunt cardiac injury is an injury to the heart as the result of blunt trauma, typically to the anterior chest wall. It can result in a variety of specific injuries to the heart, the most common of which is a myocardial contusion, which is a term ...
**
Traumatic arrest
**
Hemopericardium
Hemopericardium refers to blood in the pericardial sac of the heart. It is clinically similar to a pericardial effusion, and, depending on the volume and rapidity with which it develops, may cause cardiac tamponade.
The condition can be caused by ...
* Blood vessel injuries
**
Traumatic aortic rupture
Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. The condition is frequently fatal due to th ...
**
Thoracic aorta injury
**
Aortic dissection
Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of agonizing ches ...
* And injuries to other structures within the torso
**
Esophageal injury (
Boerhaave syndrome
Esophageal rupture, also known as Boerhaave syndrome, is a rupture of the esophageal wall. Iatrogenic causes account for approximately 56% of esophageal perforations, usually due to medical instrumentation such as an endoscopy or paraesophageal s ...
)
**
Diaphragm injury
Diagnosis
Most blunt injuries are managed with relatively simple interventions like
tracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer c ...
and
mechanical ventilation
Mechanical ventilation or assisted ventilation is the Medicine, medical term for using a ventilator, ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, wit ...
and
chest tube
A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a drain (surgery), surgical drain that is inserted through the chest wall and into the pleural space or the Mediastinum. The insertion of the tube is som ...
insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such as
CT scan
A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...
ning. Penetrating injuries often require
surgery
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...
, 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.
Outcomes
Chest trauma outcomes depend on the severity of the chest injury as well as associated injuries (such as head or spinal trauma) and the patient’s general health condition.
Early management in specialist centres offers better survival. Management is a mixture of medical (eg pain relief, respiratory support, chest drainage and antibiotics), non-medical (physiotherapy and rehabilitation) and surgical (fixation of rib fractures if appropriate and operative treatment of cardiac, lung, airway, diaphragm and oesophageal injuries).
Those who survive chest trauma and are discharged from hospital have a long-term survival comparable to the general population.
See also
*
Transmediastinal gunshot wound
*
Commotio thoracis
References
External links
{{Authority control
Medical emergencies
*