Combat injuries of the lungs and pleura: an analysis of clinical cases

Aim. To analyze the clinical cases of patients with various combat chest injuries. Materials and methods. A cross-sectional observational study enrolled 80 patients who had chest wounds in the period from 4 to 67 days (mean 23.8±12.6 days) before admission to the hospital. All study patients were men. The age of study patients varied from 20 to 59 years, mean – 39.6±8.6 years. 62.5% of study patients had mine-blast injuries. All patients underwent clinical and laboratory examination using standard methods, including determination of the C-reactive protein level, blood and biochemistry tests, calculation of leukocytes indices. The patients underwent computed tomography of the chest, and in the presence of pleural effusion, ultrasound examination of he pleural cavities. Results. Pleural effusion was registered in 68.8% of patients. The mean volume of pleural effusion was 429.3±261 ml, varying from 50 to 1000 ml. In 44 patients (80%) it was unilateral, in 11 (20%) – bilateral. Pulmonary contusion was diagnosed in 38.8% of cases. Foreign bodies in the lung parenchyma and pleural cavities were observed in 32.5% of patients, primary pneumonia – in 15% of patients, wound canal in the lung parenchyma – 10%, pneumothorax was observed in 3 patients, gas bubbles in the pleural cavities – in 5 patients. Drainage of pleural cavities at the previous stages of evacuation was performed in 58.7% of the wounded. Rib fractures were reported in 50% of the wounded. The mean level of C-reactive protein was 49.0 mg/l (0.4–325.6 mg/l), the number of leukocytes was 9.4×109/l (4–19×109/l), the number of neutrophils was 6.4×109/l (1.4–16.3×109/l), the number of platelets was 464.6×109/l (165–944×109/l), neutrophil-lymphocyte ratio – 4.1 (0.0001–17.75), neutrophil-monocyte ratio – 8,3 (0,0004–27,2), lymphocyte-monocyte ratio – 2,6 (0,11–5,8), platelets-lymphocyte ratio – 278,6 (0,01–653,3), systemic immuno-inflammatory index – 1925,9 (0,05–8296). Conclusion. In a case of combat trauma, chest injuries are often observed. The most common types of combat chest injuries are pleural effusion, pulmonary contusion and rib fractures.