Wagner R B, Crawford W O, Schimpf P P
Department of Surgery, Prince Georges' General Hospital, Cheverly, MD 20785.
Radiology. 1988 Apr;167(1):77-82. doi: 10.1148/radiology.167.1.3347751.
Pulmonary contusion, implying interstitial and alveolar injury without significant laceration, has been accepted as the primary lung injury in nonpenetrating chest trauma. Computed tomographic (CT) findings were compared with those of chest radiography in 85 consecutive patients with chest trauma in which there was a pulmonary radiodensity consistent with pulmonary contusion or patients with a history of severe chest trauma with normal parenchyma despite rib fractures, hemothorax, pneumothorax, or widened mediastinum. CT was found to be more sensitive than radiography in that 151 abnormalities (excluding rib fractures) were demonstrated on radiographs versus 423 abnormalities on CT scans, and 99 lacerations were seen on CT scans versus five on radiographs. Pulmonary lacerations were classified into four types on the basis of CT findings and mechanism of injury: compression rupture, compression shear, rib penetration, and adhesion tears. In these cases, pulmonary laceration was shown to be an integral component of the mechanism of injury in pulmonary contusion, pulmonary hematoma, pulmonary cyst or pneumatocele, or cavitation in pulmonary contusion.
肺挫伤是指在无明显撕裂伤情况下的间质和肺泡损伤，已被公认为非穿透性胸部创伤中的主要肺损伤。对85例连续胸部创伤患者的计算机断层扫描（CT）结果与胸部X线摄影结果进行了比较，这些患者中存在与肺挫伤相符的肺部放射性密度，或者有严重胸部创伤史但尽管有肋骨骨折、血胸、气胸或纵隔增宽，肺实质仍正常。发现CT比X线摄影更敏感，因为X线片显示151处异常（不包括肋骨骨折），而CT扫描显示423处异常，CT扫描发现99处撕裂伤，而X线片仅发现5处。根据CT表现和损伤机制，肺撕裂伤分为四种类型：压缩破裂、压缩剪切、肋骨穿透和粘连撕裂。在这些病例中，肺撕裂伤被证明是肺挫伤、肺血肿、肺囊肿或肺大泡形成机制的一个组成部分，或者是肺挫伤中的空洞形成机制的一部分。
