Lung injury in the intact thorax with report of a case

Abstract

LUNG injury in the intact thorax-apart from a few isolated cases-has found little mention in English surgical literature. The possibility of its occurrence, however, is familiar to most surgeons, especially after the experiences gained in war, and in the ever increasing variety of civilian injuries. There are nevertheless many instances in recent literature of failure to diagnose lung rupture when it existed : in none of the 4 fatal cases described by Villegas and de 10s Angeles was a diagnosis of lung rupture made, and in recent books dealing with athletic injuries there is no mention of this form of trauma.It can be assumed that the trauma has been applied to healthy lungs, as it is well known how easily lungs affected with tuberculosis and other lesions give way-sometimes indeed spontaneously. It must be accepted also that there is a group of cases of pneumothorax due, with or without the aid of trauma, to rupture of superficial blebs, bullre, or cysts, which, according to Gordon, cannot often be demonstrated during life. Again, the literature presents several cases of rib fracture or dislocation associated with lung injury (Lamballe, Nankivell, du Skjour, and others), but as there is often no local lesion, e.g., pleural tears, or pleural or lung contusions, these fractures or dislocations must be regarded as coincidental and not causative.The occurrence of this type of injury was recognized and described as early as 1761, when Morgagni reported the post-mortem findings in two cases. Schwartz and Dreyfus gave a good account of the condition and a review of the literature in 1907, and Fischer wrote an excellent monograph in 1912.The first recorded case in English is probably that of R. W. Smith, of Dublin, in 1840. A few points from his notes are interesting : " A man of large size was knocked down by the Inniskillen Mail which passed over his body. He was admitted to hospital with intense dyspncea and extreme emphysema at the root of the neck and chest wall. There was no hremoptysis and he died in threequarters of an hour after admission. Post-mortem examination showed collapse of the right lung with extensive pneumothorax. There was a large quantity of blood around the roots of the great vessels and aorta. There were three separate lacerations in the substance of the right lung, but no tear of the pleura was demonstrated. There were no fractured ribs." Smith described three other personal cases, one being of a dog over whose body a carriage had passed. Examination of the body showed no fractured ribs, but extensive lacerations of a lung.Many of the cases reported were the result of severe crushing violence to the chest and the diagnosis was usually not made until post-mortem examination. The diagnosis in the following case, occurring after comparatively mild trauma, was suspected clinically, and confirmed by X-ray examination.

Contusion of the Lung in Childhood

“…multiple fractures, rupture of spleen or other abdominal viscera and head injuries. Children with lung contusion alone should receive prophylactic antibiotic therapy, as infection may complicate these injuries (Fallon, 1940;Phillips, 1947). They should be kept under observation in hospital until the lungs are clear.…”

Traumatic Pulmonary Pseudocysts in a Young Dog Following Non-penetrating Blunt Thoracic Trauma

“…The development of multiple, thin-walled, air-filled cavities, or traumatic pulmonary pseudocysts (TPPs) is considered rare, occurring in <3% of adults (1, 2) and 4% of children (3) with pulmonary parenchymal injuries. TPPs were first reported by Fallon (4) and have since been reported in human literature in the form of case reports, case studies, and retrospective studies. To the author's knowledge, TPPs secondary to thoracic trauma have rarely been reported in veterinary literature (5).…”

Pulmonary hemorrhage in blunt chest trauma

“…Ушиб легкого, впервые подробно описанный Morgagni в 1761 г. [9], -наиболее распространенный вид повреждения легкого при закрытой сочетанной травме (17-70%), он служит одним из важнейших факторов, определяющих возникновение осложнений и летальный исход в посттравматическом периоде [10][11][12]. Анализ литературы свидетельствует о терминологической путанице таких понятий, как «ушиб», «контузия», «разрыв», «гематома» легкого [12].…”