Chest Trauma

Chest trauma refers to any injury affecting the structures of the chest, including the rib cage, lung parenchyma, pleura, and the contents of the mediastinum. Chest trauma is a very serious condition, a common cause of disability, and has a high mortality rate.

Depending on the nature of the injury, chest trauma is classified into two types:

• Blunt or closed chest trauma: caused by the impact of a non-cutting object on the chest. No cuts or perforations are present.
• Penetrating or open chest trauma: occurs when an object punctures the skin and enters the chest, causing an open wound.

Specific injuries affecting the chest include the following:

• Chest wall injuries, the bony structure of the chest:
  • Rib fracture: breakage of the ribs.
  • Flail chest or unstable chest: multiple fractures in three or more ribs that result in the separation of a segment of the chest wall.
  • Sternum fracture: breakage of the sternum.
  • Clavicle fracture: breakage of the clavicle.

• Pulmonary parenchyma injuries, the tissue where gas exchange occurs:
  • Pulmonary contusion: pulmonary hemorrhage with fluid accumulation (edema) and inflammation.
  • Pulmonary laceration: cut or tear of lung tissue, with varying degrees of bleeding.
  • Pneumothorax: presence of air in the pleural cavity, the space between the two layers of tissue that protect and cushion the lungs. Causes partial or complete lung collapse.
  • Hemothorax: accumulation of blood in the pleural cavity due to pulmonary or vascular hemorrhage.
  • Hemopneumothorax: simultaneous pneumothorax and hemothorax.
• Mediastinal injuries, the central compartment of the chest where the heart, major blood vessels, trachea, bronchi, and esophagus are located:
  • Pneumomediastinum: presence of air in the mediastinal interstices.
  • Aortic rupture: partial or complete rupture of the aorta.
  • Thoracic aortic injury: compression or torsion of the artery.
  • Cardiac tamponade: accumulation of blood in the pericardial sac.
  • Myocardial contusion: hematoma in the heart muscle with alteration of heart rate.
  • Blunt or non-penetrating cardiac injury: ventricular rupture, valve rupture, or cardiac concussion (sudden cardiac arrest).
  • Penetrating cardiac injury: laceration, tear, or perforation of the heart.
  • Tracheobronchial injury: partial tear or complete rupture of the trachea or bronchi.
  • Esophageal injury: contusion or laceration of the esophagus.
• Diaphragmatic injuries, the muscle membrane that separates the thoracic cavity from the abdominal cavity and plays a role in respiration:
  • Diaphragmatic rupture, usually due to penetrating trauma.

Symptoms

The specific symptoms vary depending on the exact injury. However, there are common symptoms in most chest traumas:

• Severe pain, which generally worsens with breathing.
• Breathing difficulties: rapid and shallow breathing.
• Skin hematoma.
• Irregular heart rate.
• Hypotension. • Loss or decrease in consciousness level.
• Hemorrhage in the case of penetrating trauma.
• Paradoxical breathing, if flail chest is present: the separated segment moves inward during inspiration and outward during expiration.

Causes

The most common cause of closed chest trauma is traffic accidents, but it can also occur due to direct impacts or blows from falls or assaults, or from falls from great heights, usually in work or sports accidents. Penetrating trauma, on the other hand, is caused by stab wounds, gunshot wounds, explosion fragments, or any object that can penetrate the chest.

Risk Factors

Factors that increase the risk of sustaining a chest injury include the following:

• Driving at high speeds.
• Reckless pedestrian behavior, such as crossing the street without looking, increasing the risk of being run over.
• Work or sports activities performed at great heights, such as climbing or construction work.

Complications

Many of the injuries resulting from chest trauma represent a high risk to life, as they affect respiratory and circulatory processes. The thoracic injuries with the highest potential risk of death are:

• Pneumothorax: causes ventilatory failure, leading to respiratory failure. It can also cause cardiovascular collapse due to increased pressure.
• Hemothorax: the bleeding causes hypovolemic shock because the heart cannot pump enough blood to the body, resulting in organ dysfunction.
• Unstable chest: the separated segment of the chest moves abnormally during breathing, causing a shift in the mediastinum that compresses the lung and traction on the vena cava, which alters venous return and compromises ventricular function.
• Pulmonary contusion: severe contusions affect oxygenation and can lead to pneumonia, respiratory failure, or acute respiratory distress syndrome.
• Cardiac tamponade: blood accumulation in the pericardium prevents the heart from filling with blood, thus reducing the amount of blood pumped to the body.
• Blunt cardiac injuries: any of these injuries leads to heart failure, but ventricular rupture can result in death very quickly.
• Aortic rupture: the bleeding produced is fatal in most cases, either immediately or after a few days.

Prevention

To prevent chest trauma or reduce its severity, measures must be taken against the associated risk factors:

• Drive at appropriate speeds and always use a seatbelt.
• Use the necessary protective equipment at work or during sports activities.

Which doctor treats chest trauma?

Chest trauma is evaluated and treated by specialists in thoracic surgery and the traffic unit.