A chest X-ray of a right sided<unk>  contusion associated with flail chest and subcutaneous emphysema. Contusion may mask<unk>  on chest X-ray.<unk>  may not be visible using chest X-ray because an associated<unk>  contusion or hemorrhage may mask it. As the lung contusion clears (usually within two to four days), lacerations begin to become visible on chest X-ray. CT scanning is more sensitive and better at detecting<unk>  than X-rays are, and often reveals multiple lacerations in cases where chest X-ray showed only a contusion. Before CT scanning was widely available,<unk>  was considered unusual because it was not common to find with X-ray alone. On a CT scan,<unk> s show up in a contused area of the lung, typically appearing as cavities filled with air or fluid that usually have a round or ovoid shape due to the lung's elasticity. Hematomas appear on chest radiographs as smooth masses that are round or ovoid in shape. Like lacerations, hematomas may initially be hidden on X-ray by lung contusions, but they become more apparent as the contusion begins to heal. Pneumatoceles have a similar shape to that of hematomas but have thin, smooth walls. Lacerations may be filled completely with blood, completely with air, or partially with both. Lacerations filled with both blood and air display a distinctive air-fluid level. A single laceration may occur by itself, or many may be present, creating an appearance like Swiss cheese in the radiography of the lung.<unk>  is usually accompanied by hemoptysis (coughing up blood or of blood-stained sputum). Thoracoscopy may be used in both diagnosis and treatment of<unk> . A healing laceration may resemble a lung nodule on radiographs, but unlike<unk>  nodules, lacerations decrease in size over time on radiographs. Classification In 1988, a group led by R.B. Wagner divided<unk> s into four types based on the manner in which the person was injured and indications found on a CT scan. In type 1 lacerations, which occur in the mid lung area, the air-filled lung bursts as a result of sudden compression of the chest. Also called compression-rupture lacerations, type 1 are the most common type and usually occur in a central location of the lung. They tend to be large, ranging in size from 2–8 cm. The shearing stress in type 2 results when the lower chest is suddenly compressed and the lower lung is suddenly moved across the vertebral bodies. Type 2, also called compression-shear, tends to occur near the spine and have an elongated shape. Type 2 lacerations usually occur in younger people with more flexible chests. Type 3, which are caused by punctures from fractured ribs, occur in the area near the chest wall underlying the broken rib. Also called rib penetration lacerations, type 3 lacerations tend to be small and accompanied by pneumothorax. Commonly, more than one type 3 laceration will occur. Type 4, also called adhesion tears, occur in cases where a pleuropulmonary adhesion had formed prior to the injury, in which the chest wall is suddenly fractured or pushed inwards. They occur in the subpleural area and result from shearing forces at sites of transpleural adhesion.
Pulmonary laceration
Pulmonary hematoma
Pulmonary contusion
Hemothorax
Cerebral laceration
Urinothorax
Diaphragmatic rupture
Thoracic aorta injury