Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. Blunt chest trauma and related complication is associated with 25% mortality. Lung contusion is one of the most dangerous complications of blunt chest trauma and occurs in 25-75% of all blunt chest traumas. PubMed, Elsevier and Medline search with two keywords, lung contusion and chest trauma, was done till 2016 for the most important questions. Despite of decrease in the prevalence of lung contusion, the mortality and morbidity of this entity have not been improved during the last decades, due to misunderstanding of pathophysiology.

Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia. The pathophysiology of lung contusion includes ventilation/perfusion mismatching, increased intrapulmonary shunting, increased lung water, segmental lung damage, and a loss of compliance. Clinically, patient’s presents with hypoxiemia, hypercarbia and increase in laboured breathing. Patients are treated with supplemental oxygen and mechanical ventilation whenever indicated. Treatment is primarily supportive. Computed tomography (CT) is very sensitive for diagnosing pulmonary contusion. Pulmonary contusion occurs in 25–35% of all blunt chest traumas.

Pulmonary contusion (PC) is a clinical entity that often accompanies blunt traumas. We aimed to investigate the radiological and histopathological effects of surfactant treatment in an experimental rat model in which lung contusion was formed by blunt thoracic trauma. 50 female Sprague-Dawley rats were used. Five groups were formed randomly. In groups 2, 4, and 5 lung contusion was made by the drop-weight method after anesthesia. Intratracheal surfactant was administered in the 4th hr in groups 3 and 4 and in the 24th hr in groups 4 and 5. All rats were sacrificed and their lungs removed at 48 hr after contusion. Alveolar edema, congestion, hemorrhage, destruction, leukocyte infiltration, immune staining were examined histopathologically. When the first thoracic CT scans were evaluated, we observed two rats with rib fractures and four rats with pneumothorax. 4 and 48 hr thoracic CT evaluation contusion and atelectasis showed no statistically significant decrease (P>0.05). After sacrifice of group 2, in macroscopic evaluation, there was a heterogeneous contusion and hemorrhagic appearance in the lungs of rats and less hemorrhagic appearance was observed in Groups 4 and 5 than in Group 2. In comparison of Immunohistopathological findings, surfactant treatment showed a statistically significant decrease in leukocyte infiltration scores (P=0.046). Immunohistopathologically, surfactant group had more staining but only statistically significant when compared to groups 4 and sham. (P=0.036). Surfactant treatment may be of significant benefit in lung contusion secondary to blunt chest trauma, and further prospective evidence of its efficacy in such disorders is needed.

Fracture and intrathoracic dislocation of the humeral head are extremely rare and often the result of a severe trauma. We herein report a case of humeral head fracture and dislocation with displacement into the chest cavity. A 75-year-old man fell down the stairs at home, landing on the right half of his body. Clinical impressive was a massive skin emphysema on the right hemithorax. A chest x-ray was performed. Conspicuous was a dubious opacity in the right subfield of the lung. The following CT-scan showed an additional fracture of the right scapula, a lung contusion and as “corpus delicti” a right intrathoracic dislocated humeral head fracture. The current case is extremely rare pattern of injury and the surgical emergency management is discussed. In most patients, a thoracotomy, which is related to a higher lethality and higher morbidity, can be avoided, if after stabilization a video assisted thoracoscopy is performed for revision of the pleural cavity and extraction of the humeral head.

Chest ultrasonography is routinely used in evaluation of chest trauma for diagnosis of pulmonary injury. This study aimed to evaluate the accuracy of B-Lines for diagnosing lung contusion in patients with blunt trauma of the chest. Trauma patients who met the inclusion criteria were enrolled in the study and underwent ultrasonography by trained emergency medicine residents. Ultrasound results were recorded in terms of number of B-lines and the existence of peripheral parenchymal lesion (PPL). After ultrasound, the patient underwent chest x-ray and chest CT scan (as reference test) and screening performance of B-lines and PPL were evaluated. 147 patients underwent chest ultrasound. The mean age of the patients was 40.74 ± 18.6 (78.9% male). B-lines˃3 had 94.0% (95% CI: 83.45-98.75) sensitivity and 57.7% (95% CI: 47.3-67.7) specificity, B-lines˃6 had 90.0% (95% CI: 78.2-96.7) sensitivity and 93.81% (95% CI: 87.0-97.7) specificity, and PPL had 34.0% (95% CI: 21.2-48.8) sensitivity and 100% (95% CI: 96.3-100.0) specificity. Composite findings of B-lines˃6 + PPL had 92.0% (95% CI: 80.8-97. 8) sensitivity and 93.8% (95% CI: 87.0-97.7) specificity in the diagnosis of lung contusion. PPL and B-Lines˃6 had the highest accuracy in detecting lung contusion. B-Line˃6 had high sensitivity and specificity and was easy to perform; thus, it seems that B-Line˃6 could be considered as an alternative screening tool in detection of lung contusion.

Thoracic spine fractures and their operation have many undesirable problems and complications including pneumothorax, hemothorax, chylothorax, trachea and esophagus injuries, mediastinum hematoma, rib and sternum fractures and injuries of major vessels. This study surveys the incidence of the above mentioned complications. 50 hospitalized patients in the trauma ward of Tabriz Imam Hospital from 2005 to 2010 were studied retrospectively. These patients had Thoracic spine fractures needing stabilization and fusion. 78% of the patients were male and 22% female with the mean age of 34. The most common cause of trauma was motor vehicle accidents (56%). Rib fracture was reported in 18% of the patients, pneumothorax in 10 % and lung contusion in 12%. No cases of chylothorax, major vessels and trachea and esophagus injuries or complications related to the operation were reported. Patients with thoracic spine fractures considering the extended injuries associated with primary trauma and complications related to operation in thoracic region need the cooperation of diverse specialists.

Blunt chest trauma is a rare cause of acute coronary syndrome and can be masked by other injuries in polytrauma patients. It can have devastating consequences due to damage to the myocardial tissue if left unrecognized. Myocardial injury can result in life-threatening arrhythmias and complications such as systolic and diastolic dysfunction. This can significantly affect patients’ quality of life. A 34-year-old man involved in a paragliding incident in Kazakhstan. His equipment failed at 30 meters height and result him to be propelled at high velocity to the ground. He sustained multiple injuries including spinal fractures, lung contusions and a mediastinal haematoma. He was transported to a local hospital and noted to have ST segment elevation on his admission electrocardiogram (ECG). He underwent an angiogram that showed sub-occlusion of his left anterior descending (LAD) artery. This resulted in a time-critical Percutaneous Coronary Intervention (PCI). He was stabilized and repatriated to the UK to manage of remaining injuries.

Scapular fractures are among the orthopedic injuries, which are associated with other injuries, such as lung injuries. This study aimed to evaluate the prevalence of lung injuries associated with scapular fractures in traumatic patients referred to a main trauma center in the south of Iran. The present retrospective cross-sectional study was conducted from April 2016 to June 2019 on adult traumatic patients, who were referred to one of the main trauma centers in the south of Iran, and their data were recorded in the hospital information system. The patients with chest computed tomography, and those whose scapula fractures were reported and confirmed by a radiologist were included in this study. All patients' data were extracted from their medical files and then analyzed. A total of 100 patients were enrolled, and the majority (78%) of the cases were male. The mean±SD age of the patients was 40.71±14.071 years, and 55% of the cases had lung injuries (P=0.158). Furthermore, most of the causes of scapular fracture were due to car-motorcycle accidents (30%) and car overturning (27%). Lung contusion (31%) and hemothorax (30%) were the most types of lung injuries. The mean±SD duration of hospitalization was estimated at 4.94±7.90 days. The mean age (OR=-0.207, P=0.039) and intensive care unit admission rate (OR=0.267, P=0.007) were statistically different in patients with and without lung injuries. Although scapula fractures were not significantly associated with lung injuries in this study, the occurrence of 55% of the lung injuries was clinically important, which should be considered by emergency physicians. Level of evidence: III

To evaluate the spiral chest computed tomography (CT) scan findings in patients with multipletrauma during the COVID-19 pandemic. This retrospective study was performed on multiple trauma patients admitted to a tertiary hospital inthe north of Iran in 2020. All patients with multiple trauma who had undergone a chest spiral CT were includedin this study. Furthermore, the data analysis was performed through descriptive and analytical statistics usingSPSS software. A total of 600 patients were included over the study period. The mean age of patients was 48.2±20.3years. Of the total, 496 (65.3%) patients had blunt chest injuries, and 104 (34.7%) had penetrating chest injuries.Falling was the most common mechanical cause of chest trauma in 270 patients (45%). Surgical interventionswere performed in 110 (18.3%) patients. A total of 276 (46%) patients had chest injuries identified by CTscans. Many patients (15.6%) had ground-glass lung opacity in the CT scan reports. Lung consolidation,pneumothorax, lung contusion, hemothorax, and rib fractures were the most common. Due to the high frequency of typical findings in spiral CT scan examinations, obtaining a reliablehistory of trauma severity, injury mechanism, and a detailed physical examination is recommended beforeprescribing a CT scan for patients.

Repeated physical examination and radiologic tests are necessary to prevent the complications in patients with thoracic injury. The aim of this study was to determine the cost-benefit of control chest x-ray (CXR) in these patients. In this prospective clinical trial, two groups of patients with chest trauma were evaluated. In one group, the control CXR every 6 hours was prepared and in the other group, repeated physical examination every 6 hours with only one CXR after 24 hours from admission was done. The patients had blunt or stab chest trauma without pneumothorax or hemothorax in first CXR. Data of age, sex, pneumothorax (simple or tension), hemothorax, lung contusion, hospital stay, mortality and homodynamic abnormality were collected and analyzed using chi-square test at the meaningful level of P < 0.05. Of 196 patients with mean of age 37.16 ± 17.59 years, 78% were men. There was not any tension pneumothorax or hemodynamic abnormality in two groups. Frequency of simple pneumothorax and hemodynamic abnormality was not different between the two groups (P = 0.39 and P = 1, respectively). It was possible to diagnose pneumothorax with serial physical examination in all patients (3 patients). In patients with chest trauma, repeated CXR can be replaced by repeated physical examination during first 24 hours.