Chest injuries most often affect the ribs, upper part of the abdomen, lungs, blood vessels, heart, muscles, soft tissues, and breastbone. Sometimes the esophagus, collarbone, or shoulder blade is also injured.
In the United States, chest injuries cause about 25% of deaths due to severe injury. Many of the injuries that can cause death during the first minutes or hours after injury can be treated or stabilized in the emergency department without the need for major surgery.
Causes of Chest Injuries
The chest can be injured by blunt force (such as in motor vehicle crashes, falls, or sports injuries) or by an object that penetrates it (such as a bullet or knife).
Chest injuries are often serious or immediately life threatening because they interfere with breathing or circulation. Some injuries damage the ribs and chest muscles (called the chest wall) severely enough to make it difficult for the lungs to inflate normally.
Damage to the lungs themselves interferes with gas exchange Exchanging Oxygen and Carbon Dioxide The primary function of the respiratory system is to take in oxygen and eliminate carbon dioxide. Inhaled oxygen enters the lungs and reaches the alveoli. The layers of cells lining the alveoli... read more , the main function of the lungs in which oxygen is acquired and carbon dioxide is expelled.
Chest injuries can cause circulatory problems if they result in a lot of bleeding. Bleeding is often inside the chest wall, which also interferes with breathing. Also, injury to the heart can affect circulation by interfering with the heart's ability to pump blood to the body.
Chest injuries that are common or can be severe include the following:
Cardiac tamponade Cardiac Tamponade Cardiac tamponade is pressure on the heart by blood or fluid that accumulates in the two-layered sac around the heart (pericardium). This disorder interferes with the heart's ability to pump... read more (pressure on the heart caused by accumulation of blood around it)
Injury to the aorta Injury to the Aorta The aorta—the largest artery in the body—can be partially or completely torn by severe blunt force to the chest. People with this injury have severe chest pain and often weak pulses, hoarseness... read more (a tear in the large artery that carries blood from the heart to the body)
Traumatic pneumothorax Traumatic Pneumothorax Traumatic pneumothorax occurs when air accumulates between the chest wall and the lung because of an injury. It causes the lung to collapse partially or completely. People have chest pain and... read more (air between the lung and chest wall, sometimes called a collapsed lung)
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Symptoms of Chest Injuries
The injured area is usually tender or painful. Pain is worse when people inhale. The chest may be bruised. Sometimes people are short of breath. If the injury is severe, they may feel very short of breath, drowsy, or confused, and the skin may be cold, sweaty, or blue. Such symptoms may develop when the lungs malfunction severely (respiratory failure Respiratory Failure Respiratory failure is a condition in which the level of oxygen in the blood becomes dangerously low or the level of carbon dioxide in the blood becomes dangerously high. Conditions that block... read more ) or people are in shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more . People in shock typically have dangerously low blood pressure and feel as if their heart is racing.
Other symptoms depend on the specific chest injury. For example, sometimes air accumulates under the skin in people with pneumothorax. Affected skin feels crackly and makes a crackling sound when touched. The veins in the neck are sometimes enlarged if blood or fluid accumulates in the sac around the heart and interferes with the heart's ability to pump blood (called cardiac tamponade Cardiac Tamponade Cardiac tamponade is pressure on the heart by blood or fluid that accumulates in the two-layered sac around the heart (pericardium). This disorder interferes with the heart's ability to pump... read more ) or if tension pneumothorax Tension Pneumothorax Tension pneumothorax occurs when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart. Symptoms include... read more develops.
Diagnosis of Chest Injuries
A doctor's evaluation
Usually, a chest injury is obvious. However, the severity of chest injuries cannot be determined without a doctor's evaluation.
First, doctors use a stethoscope to determine whether all parts of the lungs are receiving air, and they carefully examine the neck and chest for injuries. When someone is having difficulty breathing, a doctor places a sensor on the person's finger (pulse oximeter) to measure the amount of oxygen in the blood. Sometimes doctors measure the amount of oxygen and carbon dioxide in the blood with a blood test (arterial blood gas measurement).
A chest x-ray X-Rays of the Chest Anyone thought to have a heart disorder has chest x-rays taken from the front and the side. Typically, the person is standing upright, but chest x-rays can be done with people lying in bed if... read more is almost always taken. Chest x-ray shows most cases of pneumothorax Traumatic Pneumothorax Traumatic pneumothorax occurs when air accumulates between the chest wall and the lung because of an injury. It causes the lung to collapse partially or completely. People have chest pain and... read more , hemothorax Hemothorax Hemothorax is an accumulation of blood between the lung and the chest wall. People may feel light-headed and short of breath and have chest pain, and the skin may be cool, sweaty, or bluish... read more , and collarbone fractures Collarbone Fractures Fracture of the collarbone (clavicle) is a break in the long bone that runs horizontally from the top of the breastbone (sternum) to the top of the shoulder blade (scapula). Collarbone fractures... read more , as well as some rib fractures Rib Fractures A rib fracture is a crack or break in the bones enclosing the chest. Rib fractures cause severe pain, particularly when a person breathes deeply. A chest x-ray is usually taken. People are given... read more . However, a rapid ultrasound procedure is usually needed to look at the heart and lungs. This procedure, called E-FAST (Extended Focused Assessment With Sonography in Trauma), is used in trauma centers and emergency departments. Computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT), ultrasonography Ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more , and/or aortography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (angiography of the aorta) may be done if doctors suspect injury to the aorta.
Treatment of Chest Injuries
Support of breathing and circulation
Treatment of the specific injury
Injuries that are immediately life threatening are treated as quickly as possible. The specific treatment depends on the injury.
For all injuries, doctors take measures to support breathing and circulation if necessary. People may be given oxygen (for example, by nasal prongs, by face mask, or through a breathing tube) and intravenous fluids or sometimes blood transfusions. People with severe chest injuries are admitted to the hospital.
People may be given pain relievers (analgesics) to lessen pain.
For some injuries, a tube must be inserted into the chest (thoracostomy, or chest tube insertion Chest Tube Insertion Chest tube insertion (also called tube thoracostomy) is a procedure in which a tube is inserted into the space between the lung and chest wall (called the pleural space). The procedure is done... read more ) to drain blood (in hemothorax Hemothorax Hemothorax is an accumulation of blood between the lung and the chest wall. People may feel light-headed and short of breath and have chest pain, and the skin may be cool, sweaty, or bluish... read more ) or air (in pneumothorax Pneumothorax A pneumothorax is the presence of air between the two layers of pleura (thin, transparent, two-layered membrane that covers the lungs and also lines the inside of the chest wall), resulting... read more ) from the chest. This procedure helps collapsed lungs reinflate. Insertion can usually be done using only local anesthesia.