Unusual unilateral blunt chest trauma without rib fractures leading to pulmonary laceration requiring pneumonectomy

A 16-year-old youth was involved in an unusual automobile accident which resulted in brant 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 rang laceration complicating brant 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.