Injuries from Blunt and Penetrating Trauma
The soft tissues of the chest wall may be contused, lacerated, perforated, or avulsed as a result of blunt or penetrating trauma. These injuries generally cause little diagnostic or therapeutic trouble, since they are readily apparent on physical examination, and their physiologic impact is usually negligible. Their radiographic significance derives from the fact that they may produce abnormalities that can be confused with more significant parenchymal injuries (e.g., the density produced by a chest wall hematoma may be confused with the density produced by a parenchymal contusion) or may obscure important underlying processes (e.g., subcutaneous emphysema can make it difficult to detect underlying fractures—see Fig. 3—pneumothoraces, and a variety of parenchymal abnormalities). Correlation of radiographic findings with the results of physical examination will help to avoid the former pitfall; obtaining multiple radiographic views of the thorax (frontal, lateral, lateral decubitus) will help to steer clear of the latter. On occasion it may be necessary to resort to computed tomographic (CT) evaluation of the thorax to accurately assess the extent of skeletal, pleural, or parenchymal disease in the face of extensive subcutaneous emphysema [30, 126, 302] (Fig. 4).
KeywordsPermeability Surfactant Depression Ischemia Pneumonia
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