Pulmonary laceration
| Pulmonary laceration | |
|---|---|
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| Coronal CT scan showing lucencies (pale areas in radiography) in the lung caused by pulmonary lacerations on the left of the image (black arrows) | |
| Classification and external resources | |
| Specialty | emergency medicine |
| ICD-10 | S27.3 |
| ICD-9-CM | 861.22, 861.32 |
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 contusion does not. Pulmonary laceration is commonly caused by penetrating trauma but may also result from forces involved in blunt trauma such as shear stress. A cavity filled with blood, air, or both can form. The injury is diagnosed when collections of air or fluid are found on a CT scan of the chest. Surgery may be required to stitch the laceration, to drain blood, or even to remove injured parts of the lung. The injury commonly heals quickly with few problems if it is given proper treatment; however it may be associated with scarring of the lung or other complications.
Pulmonary laceration is a common result of penetrating trauma but may also be caused by blunt trauma; broken ribs may perforate the lung, or the tissue may be torn due to shearing forces that result from different rates of acceleration or deceleration of different tissues of the lung. Violent compression of the chest can cause lacerations by rupturing or shearing the lung tissue. Pulmonary laceration may result from blunt and penetrating forces that occur in the same injury and may be associated with pulmonary contusion. Lacerations of the lung tissue can also occur by compression of the alveoli against the ribs or spine. As with contusions, pulmonary lacerations usually occur near solid structures in the chest such as ribs. Pulmonary laceration is suspected when rib fractures are present.
In 1988, a group led by R.B. Wagner divided pulmonary lacerations into four types based on the manner in which the person was injured and indications found on a CT scan. In type 1 lacerations, which occur in the mid lung area, the air-filled lung bursts as a result of sudden compression of the chest. Also called compression-rupture lacerations, type 1 are the most common type and usually occur in a central location of the lung. They tend to be large, ranging in size from 2–8 cm. The shearing stress in type 2 results when the lower chest is suddenly compressed and the lower lung is suddenly moved across the vertebral bodies. Type 2, also called compression-shear, tends to occur near the spine and have an elongated shape. Type 2 lacerations usually occur in younger people with more flexible chests. Type 3, which are caused by punctures from fractured ribs, occur in the area near the chest wall underlying the broken rib. Also called rib penetration lacerations, type 3 lacerations tend to be small and accompanied by pneumothorax. Commonly, more than one type 3 laceration will occur. Type 4, also called adhesion tears, occur in cases where a pleuropulmonary adhesion had formed prior to the injury, in which the chest wall is suddenly fractured or pushed inwards. They occur in the subpleural area and result from shearing forces at sites of transpleural adhesion.
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