Medical Radiology - Lazar A.P. 2008

Radiation Examination of the Thoracic Organs
Traumatic Injuries of the Lungs and Pleura

Chest injuries are classified into open (penetrating) and closed (blunt). Depending on The Mechanism of injury, open chest trauma can be caused by firearms, stab wounds, or cuts, whereas closed injuries typically result from impacts, falls, or compression. Patients present with chest pain, shortness of breath, and sweating. Physical examination reveals Skin pallor, tachycardia, localized tenderness, potential bruising, and subcutaneous emphysema, alongside Acute Respiratory Failure and Shock.

Chest trauma accompanied by rib fractures is frequently complicated by pneumothorax due to laceration of the pulmonary parenchyma and visceral Pleura, allowing air to enter the pleural cavity. Air may also enter the pleural cavity externally through a chest wound. On radiographs, pneumothorax appears as a peripheral radiolucency with an absent pulmonary vascular pattern in the affected hemithorax, accompanied by lung collapse (Figs. 106, 107). In cases of open pneumothorax, air can dissect into the soft Tissues of the chest wall, resulting in subcutaneous emphysema. This is clinically detectable by Palpation, while radiographic findings show a characteristic "feather-like" pattern beneath the skin at the lung level caused by air dissecting through the Muscle planes.

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Fig. 108. Thromboembolism of the lower lobe artery of the right lung on a radiograph (A), ventilation-perfusion scintigrams (B - anterior view, C - posterior view), and an angiopulmonogram (D).

Pneumothorax is frequently accompanied by vascular rupture, pleural Hemorrhage, and The Development of hemopneumothorax. Radiographically, this presents as a radiolucency without a pulmonary vascular pattern in the upper portions of the affected hemithorax, and a homogeneous opacity with a horizontal fluid level in the lower portions that remains horizontal despite changes in body position.

Spontaneous pneumothorax can arise as a complication of various pulmonary conditions (such as tuberculosis, emphysema, or cysts) due to the involvement of the visceral pleura in the pathological process, leading to its rupture.

Pneumothorax is most accurately diagnosed using computed tomography, which can detect even trace amounts of air within any pleural recesses that are inaccessible on standard radiographs—such as the vertebromediastinal recess—as well as air that has entered the Mediastinum via a ruptured bronchus and spread along peribronchial and perivascular spaces.