CASE 558 Published on 24.07.2001

Teaching Case

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

65 years, female

Categories

No Area of Interest ; Imaging Technique CT ;

No Procedure ; No Special Focus ;

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Clinical History

Traffic accident

Differential Diagnosis List

Blunt traumatic pulmonary lacerations devoid of surrounding pulmonary contusions

Imaging Findings

Alcoholized 65-year-old female patient involved in a high-speed traffic accident. Admission radiological survey included a spiral chest CT, performed because of the accident deceleration biomechanics.

Discussion

Pulmonary lacerations designate severe lung tissue damage, with extensive alveolar ruptures. They may either relate to blood-filled pulmonary hematomas or, especially in young people, to air-filled pneumatoceles or pseudo-cysts. The elastic recoil forces of the surrounding intact pulmonary tissue are responsible for the round or ovoid shape of these intrapulmonary cavities. Most of pulmonary lacerations are totally blurred by large areas of lung contusion that surround them, and thus not depicted on initial plain films. They are progressively exposed due to the resolution of the surrounding contusions, a few days after trauma.

References

[1] Garcia Rio F, Granados S, Pino Garcia JM, et al (1994)
Bilateral diffuse infiltrate masking a cavity after blunt chest trauma.
Chest 106: 1575-1576. (PMID: 7956421)

[2] Tabib A, Loire R, Pinet A, et al (1989)
Les contusions pulmonaires. Aspects anatomo-radiologiques.
Arch Anat Cytol Pathol 37: 148-152. (PMID: 2817998)

[3] Wagner RB, Crawford WO Jr, Schimpf PP (1988)
Classification of parenchymal injuries of the lung.
Radiology 167: 77-82. (PMID: 3347751)

[4] Wintermark M, Duvoisin B, Schnyder P (2000) Trauma of the pulmonary parenchyma. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 57-69.

Case information