Pulmonary laceration pathophysiology: Difference between revisions
Created page with "__NOTOC__ {{Pulmonary laceration}} {{CMG}} ==Overview== ==Pathophysiology== [[Image:Pneumothorax CT.jpg|thumb|left|200px|A CT scan of a pneumothorax, a chest injury that may ..." |
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cite book ||chapter=Trauma to the chest wall and lung|author = Livingston DH, Hauser CJ |title=Trauma. Fifth Edition |editor=Moore EE, Feliciano DV, Mattox KL |year= 2003 |publisher= McGraw-Hill Professional | isbn= 0071370692 |url= http://books.google.com/books?id=VgizxQg-8QQC&dq=pulmonary+contusion&client=firefox-a&source=gbs_summary_s&cad=0 | accessdate=2008-04-26 |pages=532 | cite book ||chapter=Trauma to the chest wall and lung|author = Livingston DH, Hauser CJ |title=Trauma. Fifth Edition |editor=Moore EE, Feliciano DV, Mattox KL |year= 2003 |publisher= McGraw-Hill Professional | isbn= 0071370692 |url= http://books.google.com/books?id=VgizxQg-8QQC&dq=pulmonary+contusion&client=firefox-a&source=gbs_summary_s&cad=0 | accessdate=2008-04-26 |pages=532 | ||
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</ref> and into the [[pleural cavity |pleural space]], if the laceration goes through to it. | </ref> and into the [[pleural cavity |pleural space]], if the laceration goes through to it. Pulmonary laceration invariably results in [[pneumothorax]] (due to torn [[airway]]s), [[hemothorax]] (due to torn [[blood vessel]]s), or a [[hemopneumothorax]] (with both blood and air in the chest cavity).<ref name="Gwinnutt03"> | ||
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cite book |author=Kishen R, Lomas G |chapter=Thoracic trauma |editor=Gwinnutt CL, Driscoll P |title=Trauma Resuscitation: The Team Approach |publisher=Informa Healthcare |location= |year=2003 |isbn=1-85996-009-X |oclc= |doi= |accessdate=2008-05-03 |pages=64 |url= http://books.google.com/books?id=bzm12Y1RhBAC&pg=PA64&dq=pulmonary+laceration&lr=&client=firefox-a&sig=siPnk1jd_rKlmRZgPGQAWSW0UrQ | cite book |author=Kishen R, Lomas G |chapter=Thoracic trauma |editor=Gwinnutt CL, Driscoll P |title=Trauma Resuscitation: The Team Approach |publisher=Informa Healthcare |location= |year=2003 |isbn=1-85996-009-X |oclc= |doi= |accessdate=2008-05-03 |pages=64 |url= http://books.google.com/books?id=bzm12Y1RhBAC&pg=PA64&dq=pulmonary+laceration&lr=&client=firefox-a&sig=siPnk1jd_rKlmRZgPGQAWSW0UrQ | ||
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</ref> Unlike hemothoraces that occur due to pulmonary contusion, those due to lung laceration may be large and long lasting. | </ref> Unlike hemothoraces that occur due to pulmonary contusion, those due to lung laceration may be large and long lasting. However, the lungs do not usually bleed very much because the blood vessels involved are small and the pressure within them is low. Therefore, pneumothorax is usually more of a problem than hemothorax. A pneumothorax may form or be turned into a [[tension pneumothorax]] by [[mechanical ventilation]], which may force air out of the tear in the lung. | ||
The laceration may also close up by itself, which can cause it to trap blood and potentially form a [[cyst]] or [[hematoma]]. | The laceration may also close up by itself, which can cause it to trap blood and potentially form a [[cyst]] or [[hematoma]]. Because the lung is elastic, the tear forms a round cyst called a ''traumatic air cyst'' that may be filled with air, blood, or both and that usually shrinks over a period of weeks or months.<ref name="Helms07"> | ||
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cite book |author=Helms CA, Brant WE |title=Fundamentals of Diagnostic Radiology |publisher=Lippincott, Williams & Wilkins |location=Philadelphia |year=2007 |pages=557 |isbn=0-7817-6135-2 |oclc= |doi= |accessdate=2008-04-29 |url=http://books.google.com/books?id=Sossht2t5XwC&pg=PA557&dq=pulmonary+laceration&client=firefox-a&sig=qhs0_eVneANRDtc8W8opdYhvLRg#PPA557,M1 | cite book |author=Helms CA, Brant WE |title=Fundamentals of Diagnostic Radiology |publisher=Lippincott, Williams & Wilkins |location=Philadelphia |year=2007 |pages=557 |isbn=0-7817-6135-2 |oclc= |doi= |accessdate=2008-04-29 |url=http://books.google.com/books?id=Sossht2t5XwC&pg=PA557&dq=pulmonary+laceration&client=firefox-a&sig=qhs0_eVneANRDtc8W8opdYhvLRg#PPA557,M1 | ||
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</ref> Lacerations that are filled with air are called [[pneumatocele]]s, and those that are filled with blood are called '''pulmonary hematomas'''.<ref name="White99"/> In some cases, both pneumatoceles and hematomas exist in the same injured lung. | </ref> Lacerations that are filled with air are called [[pneumatocele]]s, and those that are filled with blood are called '''pulmonary hematomas'''.<ref name="White99"/> In some cases, both pneumatoceles and hematomas exist in the same injured lung. A pneumatocele can become enlarged, for example when the patient is mechanically ventilated or has [[acute respiratory distress syndrome]], in which case it may not go away for months. Pulmonary hematomas take longer to heal than simple pneumatoceles and commonly leave the lungs scarred.<ref name="White99"> | ||
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cite book |author=White C, Stern EJ |title=Chest Radiology Companion |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=1999 |pages=80, 176 |isbn=0-397-51732-7 |oclc= |doi= |accessdate=2008-04-30 |url=http://books.google.com/books?id=keNyAl8AArUC&pg=PA176&dq=pulmonary+laceration&lr=&client=firefox-a&sig=wvrEbz3w48sBnRaXtSxF9E6DwzM#PPA80,M1 | cite book |author=White C, Stern EJ |title=Chest Radiology Companion |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=1999 |pages=80, 176 |isbn=0-397-51732-7 |oclc= |doi= |accessdate=2008-04-30 |url=http://books.google.com/books?id=keNyAl8AArUC&pg=PA176&dq=pulmonary+laceration&lr=&client=firefox-a&sig=wvrEbz3w48sBnRaXtSxF9E6DwzM#PPA80,M1 | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
A pulmonary laceration can cause air to leak out of the lacerated lung[1] and into the pleural space, if the laceration goes through to it. Pulmonary laceration invariably results in pneumothorax (due to torn airways), hemothorax (due to torn blood vessels), or a hemopneumothorax (with both blood and air in the chest cavity).[2] Unlike hemothoraces that occur due to pulmonary contusion, those due to lung laceration may be large and long lasting. However, the lungs do not usually bleed very much because the blood vessels involved are small and the pressure within them is low. Therefore, pneumothorax is usually more of a problem than hemothorax. A pneumothorax may form or be turned into a tension pneumothorax by mechanical ventilation, which may force air out of the tear in the lung.
The laceration may also close up by itself, which can cause it to trap blood and potentially form a cyst or hematoma. Because the lung is elastic, the tear forms a round cyst called a traumatic air cyst that may be filled with air, blood, or both and that usually shrinks over a period of weeks or months.[3] Lacerations that are filled with air are called pneumatoceles, and those that are filled with blood are called pulmonary hematomas.[4] In some cases, both pneumatoceles and hematomas exist in the same injured lung. A pneumatocele can become enlarged, for example when the patient is mechanically ventilated or has acute respiratory distress syndrome, in which case it may not go away for months. Pulmonary hematomas take longer to heal than simple pneumatoceles and commonly leave the lungs scarred.[4]
Over time, the walls of lung lacerations tend to grow thicker due to edema and bleeding at the edges.[5]
References
- ↑ Livingston DH, Hauser CJ (2003). "Trauma to the chest wall and lung". In Moore EE, Feliciano DV, Mattox KL. Trauma. Fifth Edition. McGraw-Hill Professional. p. 532. ISBN 0071370692. Retrieved 2008-04-26.
- ↑ Kishen R, Lomas G (2003). "Thoracic trauma". In Gwinnutt CL, Driscoll P. Trauma Resuscitation: The Team Approach. Informa Healthcare. p. 64. ISBN 1-85996-009-X. Retrieved 2008-05-03.
- ↑ Helms CA, Brant WE (2007). Fundamentals of Diagnostic Radiology. Philadelphia: Lippincott, Williams & Wilkins. p. 557. ISBN 0-7817-6135-2. Retrieved 2008-04-29.
- ↑ 4.0 4.1 White C, Stern EJ (1999). Chest Radiology Companion. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. 80, 176. ISBN 0-397-51732-7. Retrieved 2008-04-30.
- ↑ Invalid
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