Learning Radiology xray montage

Pulmonary Laceration
Traumatic Pneumatocele

General Considerations

  • Most thoracic trauma is due to motor vehicle accidents
  • Most thoracic trauma is blunt, rather than penetrating
  • Lacerations usually result from blunt chest trauma
  • They represent tears in the lung parenchyma
  • Lacerations filled with air are called pneumatoceles, and those filled with blood are called pulmonary hematomas
  • They tend to occur more often in children and young adults

Clinical Findings

  • No symptoms from laceration itself unless it becomes infected,
    which is rare

Imaging Findings

  • Usually not apparent at first because of surrounding pulmonary
    • Contusions characteristically clear rapidly, sometimes within
      48 hours
  • On CT, they will present as cystic lucencies, frequently beneath a rib fracture
    • CT is more sensitive than conventional radiographs for detecting a pulmonary laceration
  • Half are solid, mass-like lesions (pulmonary hematoma)

Pulmonary Hematoma

Pulmonary Hematoma. Following blunt chest trauma on the left, a small, solid-appearing, soft tissue nodule appeared in the lingula (red arrows) representing pulmonary laceration filled with blood.

  • Half are thin-walled cystic structures (traumatic lung cyst
    or pneumatoceles) with or without air-fluid level — depends on
    how much bleeding into laceration
  • Usually subpleural location under point of maximum impact
    • May be single or multiple


  • Supportive: oxygen, assisted ventilation if needed


  • Characteristically, they take a long time to heal – weeks to months
    • Gradually decrease in size

Pulmonary laceration

Pulmonary laceration. CT of the chest demonstrates a partially-cystic,
partially fluid-filled structure in the left lower lobe (red arrow) near a rib fracture (black arrow)
in this patient who was an unrestrained passenger in a motor vehicle collision. The blue arrow
points to an area of subpleural hemorrhage representing a pulmonary contusion

For a photo of the same image without arrows, click here


Pulmonary laceration


Pulmonary laceration. CT of the chest again demonstrates a cystic,
partially fluid-filled structure in the left lower lobe (white arrow) surrounded by a pulmonary contusion (yellow arrow) There is subcutaneous emphysema (red arrow) from the stab would.


Pulmonary laceration


Pulmonary laceration. Upright chest radiograph shows a "solid"
appearing structure in the left hemithorax representing a blood-filled traumatic pneumatocoele. The patient had been shot (red arrow points to bullet). There are already two chest tube in place.


Pulmonary laceration


Pulmonary laceration. Chest CT shows a thin-walled cavity (white arrow) with
surrounding pulmonary hemorrhage (red arrow).