In this chapter we will discuss traumatic injuries to the chest wall and the thoracic viscera. Chest wall injuries include the skin, subcutaneous tissue, intercostal musculature, ribs, sternum, and parietal pleura. Thoracic visceral injuries include two main categories: (1) mechanical injuries of the respiratory system, which will include diaphragmatic rupture. The inclusion of diaphragmatic rupture is due to the fact clinically it presents with symptoms analagous to pneumothorax. (2) mechanical injuries of the cardiovascular system, which will include the mediastinum. This is primarily due to the fact the most common cause of a widen mediastinum is aortic rupture. We will also discuss the mechanisms of chest injury. Prior to a discussion of the blunt force traumatic injuries of the chest and mechanisms of chest injury, we will review the anatomy of the thorax.
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Forensic Medicine with Dr. Cox 
8 comments
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March 2, 2012 at 11:16 pm
Andy McLoughlin
Dr. Cox,
I had the pleasure of working with you during my time as a PA student at The Ohio State University. I came across this blog unexpectedly while researching skull fractures. It’s a fantastic resource with a wealth of information, thank you for taking the time to put these articles together! Best regards,
Andy McLoughlin
May 7, 2013 at 10:53 am
bcoxmd
Thank you for your thoughtful comment. It is very much appreciated.
Have a good day,
Bill Cox
May 14, 2013 at 11:35 am
Andy McLoughlin
Dr. Cox,
Within any of your articles, have you discussed the Morel-Lavallee lesion? Most of the online references I’ve found on the topic are very brief and nondescript. Thanks much! Best,
Andy
May 7, 2013 at 5:56 am
in car camera system
What a material of un-ambiguity and preserveness of precious knowledge about unpredicted emotions.
August 13, 2013 at 7:06 am
Roland
Dear Dr. Cox,
I am searching for literature about the origin of superficial bruises caused by blunt impacts. Do you have some recommendations? Your exposé seems to me a suitable introduction for this issue. I am a researcher in robotics and very interested in the effects of blunt impacts due to collisions between humans and robots. It was hard to find suitable (academic) literature so far, espacially about the origin of bruises (hematoma, edema, etc.).
Best,
Roland
August 14, 2013 at 1:00 pm
bcoxmd
Hello Roland,
To my knowledge there is nothing in the forensic literature specifically addressing blunt impact injury produced by a collision between humans and robots. The reason for this may be rest in what constitutes a contusion, the definition of which has not changed since that given by Alan Mortiz’s in the “Pathology of Trauma”, the second edition of which was published in 1954. Mortiz’s definition is as follows, “A contusion or bruise represents the effect on tissues of an impact or pressure and is ordinarily recognized by the presence of extravasated blood into the injured tissues without gross (external) disruption of tissue continuity. The essential lesions are microscopic lacerations of the smallest blood vessels.” In short Roland, unless the impact with a robot is unique, distinctive, is not found in blunt impact injury with any other object, than the resulting contusion from such an impact with a human is going to be no different from impact with any other object. This is why you are having a hard time finding such literature. To be honest I have not considered this issue in all of my reading, teaching and writing. To further help you, some objects will induce what is referred to as “signiture contusions”, in which the imprints on the surface of the impacting object are imprinted, via contusions, on the surface of the skin, such as the pattern on the sole of the shoe, which has been used to stomp on a person. It is a “signiture contusion” because you can match the pattern on the skin with the pattern on the sole of the shoe. Unless robots leave such unique contusions, you are not going to find any such literature specific to robots. I am certain as time goes on, and robots become an integral part of our lives, there are going to be collisions between humans and robots and yes there will be contusions, albeit on humans.
I hope I have been of help to you.
Bill Cox
August 20, 2013 at 12:59 pm
Roland
Thanks Mr Cox for your detailed answer! I will have a closer look on “contusions” for my further work. But up to now I’m sure that “signiture contusions” won’t be an key-issue for physical human-robot collaboration since the robot must be covered with a soft surface of rubber to avoid high stress spots within the collision area. Furthermure, the shape of such robots must be close to spherical primitives. And if I understand it right, the signiture of a contusion is caused by high strain of the skin that surrounds the contact area??
To the background: My current work focuses on the origin of bruises and its causes in term of mechanical loading (speed of a reflected mass and the shape of the contact area). And it is essential for me to understand the internal mechanism that lead to a bruise within human tissue. I would appreciate it if you have further literature recommendations about contusions.
Thanks,
Roland
August 23, 2013 at 3:44 pm
bcoxmd
Hello Roland,
I hope all is well with you. The area that may be of interest to you is the Biomechanics/Biophysics/Biokinetics of impact injury. I utilized this area in resolving a case in which the defense claimed the toddler died from impact injury inflicted by his 6 and 9 year old sisters rather than the live-in-boyfriend, who had been discharged from the Marines because of his uncontrollable violence against not only his fellow Marines but also a child of his girlfriend.
I will work on identifying specific articles for you.
I hope I have been of some help.
Have a great weekend,
Bill