Ruptured Lung in Football

Although closed head, abdominal, and chest trauma are less frequent athletic injuries than sprains and strains, prompt recognition of these rarer conditions is necessary to avoid catastrophe.

A case of blunt chest trauma is presented which resulted in a pneumothorax in the absence of rib fractures. In this case, the correct diagnosis resulted from the combination of a careful history, physical examination, and a high degree of suspicion.

The student required hospitalization with a chest tube to remove air from the chest cavity (external to the lung). Barotrauma resulting from spear tackling was considered the cause. Barotrauma is overdistension and rupture of the alveolar sacs caused by high airway pressures from a blow to the chest wall. Football players probably sustain this sudden increase in airway pressure by being struck at full inspiration against closed vocal cords.

A classic pneumothorax presents with a pleuritic type chest pain and dyspnea. However, in young, well-conditioned athletes, these signs are often minimized and must be sought carefully. Further signs of worsening pneumothorax causing tension in the mediastinal organs include tachycardia, worsening dyspnea, cyanosis, and tracheal deviation. Physical findings on the affected side include decreased breath sounds and hyperresonance, because the sound is partially transmitted through air and not through the lung tissue as on the normal side.

Any time an athlete sustains trauma to the chest region and has temporary dyspnea, the athlete must be removed from the game for observation.

(Funk D et al. Pneumothorax in high school football. Texas Medicine 1998; 94(5):72-74)

COMMENT: Something to consider when you are confronted with a disproportionately out-of-breath athlete (with or without chest pain).