Pulmonary laceration pathophysiology
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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.[2] 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).[3] Unlike hemothoraces that occur due to pulmonary contusion, those due to lung laceration may be large and long lasting.[4] However, the lungs do not usually bleed very much because the blood vessels involved are small and the pressure within them is low.[5] Therefore, pneumothorax is usually more of a problem than hemothorax.[2] 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.[4]
The laceration may also close up by itself, which can cause it to trap blood and potentially form a cyst or hematoma.[2] 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.[6] Lacerations that are filled with air are called pneumatoceles, and those that are filled with blood are called pulmonary hematomas.[7] In some cases, both pneumatoceles and hematomas exist in the same injured lung.[4] 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.[4] Pulmonary hematomas take longer to heal than simple pneumatoceles and commonly leave the lungs scarred.[7]
Over time, the walls of lung lacerations tend to grow thicker due to edema and bleeding at the edges.[8]
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.
- ↑ 2.0 2.1 2.2 Invalid
<ref>tag; no text was provided for refs namedmlr07 - ↑ 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.
- ↑ 4.0 4.1 4.2 4.3 Invalid
<ref>tag; no text was provided for refs namedGavelli02 - ↑ Invalid
<ref>tag; no text was provided for refs namedMatthay05 - ↑ Helms CA, Brant WE (2007). Fundamentals of Diagnostic Radiology. Philadelphia: Lippincott, Williams & Wilkins. p. 557. ISBN 0-7817-6135-2. Retrieved 2008-04-29.
- ↑ 7.0 7.1 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
<ref>tag; no text was provided for refs namedKarmy02