Lung Injury

  • Vittorio Miele
  • Grazia Loretta Buquicchio
  • Claudia Lucia Piccolo
  • Alessandro Stasolla
  • Michele Galluzzo
Part of the Medical Radiology book series (MEDRAD)


Thoracic trauma is the most common injury in polytrauma patients, with an incidence rate of 45–65%, and the most common cause of trauma deaths (about 20 % of all deaths), second only to head injuries.

In the time-sensitive acute care setting, efficiency and rapidity are basic. The Chest-X-Ray (CXR) may be considered as an adjunct to the initial assessment or primary survey of unstable traumatic patients. It helps to identify a tension pneumothorax (PNX) and pleural effusions that may suggest a hemothorax, until further evidence.

MultiSlice Computed Tomography (MSCT) is always the last step of the diagnostic procedures for stable patients, regardless of the positive or negative results on CXR, being the gold standard for the radiologic evaluation of the chest in traumatic patients.

This chapter will review the wide spectrum of radiographic and MSCT findings in patients undergoing a thoracic trauma, both blunt and penetrating, with a particular focus on the role of the radiologist in the management of major trauma, together with the “trauma team”.


Blunt Chest Trauma Thoracic Trauma Advance Trauma Life Support Tension Pneumothorax Pulmonary Contusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Cohn SM (1997) Pulmonary contusion: review of the clinical entity. J Trauma 42:973–979CrossRefPubMedGoogle Scholar
  2. Gaillard M, Hervé C, Mandin L, Raynaud P (1990) Mortality prognostic factors in chest injury. J Trauma 30:93–96CrossRefPubMedGoogle Scholar
  3. Ianniello S, Di Giacomo V, Sessa B, Miele V (2014) First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med 119: 674–680.Google Scholar
  4. Mayberry JC (2000) Imaging in thoracic trauma: the trauma surgeon’s perspective. J Thorac Imaging 15:76–86CrossRefPubMedGoogle Scholar
  5. Miele V, Di Giampietro I, Ianniello S, Pinto F, Trinci M (2014) Diagnostic imaging in pediatric polytrauma management. Radiol Med 120:33–49Google Scholar
  6. Peters S, Nicolas V, Heyer CM (2010) Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients. Clin Radiol 65:333–338CrossRefPubMedGoogle Scholar
  7. Rivas LA, Fishman JE, Munera F et al (2003) Multislice CT in thoracic trauma. Radiol Clin North Am 41:599–616CrossRefPubMedGoogle Scholar
  8. Roy-Choudhury SH, Gallacher DJ, Pilmer J et al (2007) Relative threshold of detection of active arterial bleeding: In vitro comparison of MDCT and digital subtraction angiography. AJR Am J Roentgenol 189:W238–W246CrossRefPubMedGoogle Scholar
  9. Ryan MF, Hamilton PA, Chu P et al (2004) Active extravasation of arterial contrast agent on post-traumatic abdominal computed tomography. Can Assoc Radiol J 55:160–169PubMedGoogle Scholar
  10. Scaglione M, Pinto A, Pedrosa I et al (2008) Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol 65:377–388CrossRefPubMedGoogle Scholar
  11. Scott MF, Khodaverdian RA, Shaheen JL et al (2015) Predictors of retained hemothorax after trauma and impact on patient outcomes. Eur J Trauma Emerg Surg. Epub ahead of printGoogle Scholar
  12. Shanmuganathan K, Mirvis SE (1999) Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am 37:533–551CrossRefPubMedGoogle Scholar
  13. Sivit CJ, Peclet MH, Taylor GA (1989) Life-threatening intraperitoneal bleeding: demonstration with CT. Radiology 71:430CrossRefGoogle Scholar
  14. Traub M, Stevenson M, McEvoy S et al (2007) The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury 38:43–47CrossRefPubMedGoogle Scholar
  15. Trindade LM, Lopes LC, Cipriano GF et al (2009) Alveolar recruitment in pulmonary contusion: case report and literature review. Rev Bras Ter Intens 21:104–108CrossRefGoogle Scholar
  16. Ulutas H, Celik MR, Ozgel M et al (2015) Pulmonary pseudocyst secondary to blunt or penetrating chest trauma: clinical course and diagnostic issues. Eur J Trauma Emerg Surg 41:181–188CrossRefPubMedGoogle Scholar
  17. Van Hise ML, Primack SL, Israel RS et al (1998) CT in blunt chest trauma: indications and limitations. Radiographics 18:1071–1084CrossRefPubMedGoogle Scholar
  18. Wagner RB, Crawford WO Jr, Schimpf PP (1988) Classification of parenchymal injuries of the lung. Radiology 167:77–82CrossRefPubMedGoogle Scholar
  19. Wanek S, Mayberry JC (2004) Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin 20:71–81CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Vittorio Miele
    • 1
  • Grazia Loretta Buquicchio
    • 1
  • Claudia Lucia Piccolo
    • 1
  • Alessandro Stasolla
    • 1
  • Michele Galluzzo
    • 1
  1. 1.Department of Emergency RadiologyS. Camillo HospitalRomeItaly

Personalised recommendations