Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 230-231
Contre-coup injury in chest: Report of two cases


Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

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Date of Web Publication20-Jul-2013
 

How to cite this article:
Kumar S, Joshi MK, Qureshi AQ. Contre-coup injury in chest: Report of two cases. J Emerg Trauma Shock 2013;6:230-1

How to cite this URL:
Kumar S, Joshi MK, Qureshi AQ. Contre-coup injury in chest: Report of two cases. J Emerg Trauma Shock [serial online] 2013 [cited 2020 Jan 21];6:230-1. Available from: http://www.onlinejets.org/text.asp?2013/6/3/230/115357


Sir,

Contre-coup injuries are well-described in relation to traumatic brain injuries. However, literature is scarce regarding the existence of similar injuries elsewhere. Although textbooks mention contre-coup injuries in chest, [1],[2] we could find only one definitive report in the literature. [3]

We encountered two patients of blunt thoracic trauma leading to contre-coup injury in the chest and consider them worth mentioning through the platform of your esteemed journal. Our first patient was 50-year-old who was hit on his right side by a moving heavy vehicle. He presented with tachycardia and tachypnea. Chest examination revealed abrasions, tenderness, crepitation, and subcutaneous emphysema on the right side. Air-entry was decreased bilaterally. There were no signs of external injuries on the left side of the chest. Chest X-ray revealed the fracture of the clavicle, third and fourth ribs with hemopneumothorax on the right side and hemothorax on the left side [Figure 1]. Bilateral chest drains were inserted which immediately drained 200 ml of blood with some air on the right side and 700 ml of blood on the left side. He recovered well with this treatment and was discharged after 5 days following removal of chest drains.
Figure 1: Chest X-ray of patient one showing fracture of the right clavicle, third and fourth ribs with hemopneumothorax and left hemothorax

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The other patient was an 18-year-old riding a two-wheeler who was hit by a car resulting in the fall on his right side. He presented with pain in the right side of the chest and tachypnea. He had tenderness and bony crepitus over right clavicle and upper chest anteriorly and posteriorly. Air entry was decreased bilaterally. Chest X-ray revealed right sided pneumothorax and fractures of right scapula, clavicle and 3 rd and 4 th ribs, and hemothorax and pulmonary contusion on the left side [Figure 2]. Contrast enhanced tomographic scan chest confirmed X-ray findings [Figure 3]. Bilateral intercostal chest tube drains were inserted, which drained air and minimal blood on the right side and 300 ml of blood on the left side. Right sided chest tube was removed after 4 days. Left side was complicated by retained hemothorax, which was managed by video assisted thoracoscopic adhesiolysis and drainage.
Figure 2: Chest X-ray of patient two showing right sided pneumothorax and fractures of right scapula, clavicle and 3rd and 4th ribs, and hemothorax and pulmonary contusion on the left side

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Figure 3: Contrast enhanced computerized tomographic scan thorax of patient two confirming X-ray findings

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These cases exemplify that like brain, contre-coup injuries can also occur in the chest. The mechanism of contre-coup injury can be explained by Newton's first law of motion, which states that: A body tends to remain in the state of rest or of uniform motion unless compelled to change that state by external forces. Like brain in the skull, intrathoracic organs are suspended inside the thorax and are mobile to a limited extent. Following a blow, the underlying lung may sustain injury at the site of impact (coup injury). Owing to blow, the torso moves in the direction of blow, but when strikes a stationary platform the moving intrathoracic organs collide violently against the stationary thoracic cage on the site opposite to that of the blow, resulting in contre-coup injury.

Contre-coup injury has also been reported at various extra-cranial sites. [3],[4],[5] The meager cases reported so far may be due to lack of appreciation of existence of this entity. This also reinforces the importance of examining the whole chest carefully irrespective of the external injuries.

 
   References Top

1.Wintermark M, Duvoisin B, Schnyder P. Trauma of the pulmonary parenchyma. In: Schnyder P, Wintermark N, Baert AL, editors. Radiology of blunt trauma to chest. New York: Springer; 2000. p. 57-9.  Back to cited text no. 1
    
2.Stern E. Imaging of blunt and penetrating trauma to pulmonary parenchyma. In: Jones RK, Nathens A, Stern EJ, editors. Thoracic Trauma and Critical Care. Washington: Springer; 2002. p. 159-62.  Back to cited text no. 2
    
3.Rashid MA. Contre-coup lung injury: Evidence of existence. J Trauma 2000;48:530-2.  Back to cited text no. 3
[PUBMED]    
4.Huang YC, Liu P, Su JS, Lin YL. Contrecoup haemorrhage in a patient with left pubic fracture but right obturator artery bleeding. Emerg Med J 2007;24:598-9.  Back to cited text no. 4
[PUBMED]    
5.Moccetti M, Wyttenbach R, Santini P, Previsdomini M, Corti R, Gallino A. Images in cardiovascular medicine. Posttraumatic cardiac contrecoup: In vivo evidence by cardiac magnetic resonance imaging. Circulation 2009;119:1538-40.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Sunil Kumar
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.115357

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