Unusual Unilateral Blunt Chest Trauma without Rib Fractures Leading to Pulmonary Laceration Requiring Pneumonectomy

¹ Divisions of Pulmonary Medicine and Thoracic Surgery, The Queens Hospital Center Affiliation of the Long Island Jewish-Hillside Medical Center, New York City, and the School of Medicine of the Health Sciences Center, State University of New York at Stony Brook

A 16-year-old youth was involved in an unusual automobile accident which resulted in blunt chest trauma localized to the right hemithorax. There were no rib fractures on the side of injury, but contusion of the right lung with severe and persistent right hemothorax necessitated a thoracotomy, whereupon multiple deep lacerations were found involving all the lobes of the right lung. In addition, there was disruption of the bronchi and major vessels, and right pneumonectomy was performed. This is the first reported case of pneumonectomy being required for lung laceration complicating blunt chest trauma. Postoperatively there were two episodes of spontaneous pneumothorax in the contralateral pleural space, as well as a transient air leak into the pneumonectomy space. The possible mechanisms for the lung injury and the postoperative tension disorders are described.