Blunt chest trauma puts multiple structures at risk of injury. In addition to direct trauma, rapid deceleration and other mechanisms can cause injury to thoracic structures. Major concerns include chest wall injury, such as rib fractures or flail chest; cardiovascular injury, such as blunt aortic injury or cardiac contusion; and pulmonary injury, such as contusions or lacerations. Blunt aortic injury is the most lethal injury of the thorax if untreated.
The clinician must first concentrate on assessing life-threatening conditions. Depending on the presentation, evaluation may consist solely of a thorough history and physical examination or may require multiple tests including plain x-rays, computed tomography (CT) scans, and echocardiography.
This topic review will discuss the epidemiology, mechanisms, and general approach to the management of injuries sustained in adults from blunt thoracic trauma. Discussions of thoracic trauma in children and other aspects of trauma management are found separately. (See "Initial evaluation and stabilization of children with thoracic trauma" and "Initial evaluation and management of rib fractures" and "Initial management of trauma in adults".)
Motor vehicle collisions (MVC) represent the most common cause of major thoracic injury among emergency department (ED) patients [1,2]. Several factors are associated with a higher risk of thoracic injury:
- High speed
- Not wearing a seatbelt
- Extensive vehicular damage
- Steering wheel deformity