Chest Bruises: When to Seek Medical Attention After Trauma

A chest contusion is a type of bruise that can cause pain during breathing?

My boyfriend struck me forcefully in the area just below my chest, around the costal arch (slightly towards the left side below the left breast) during an argument.
I experienced about one to two seconds of inability to breathe, followed by severe chest pain.
I initially thought I had a broken rib and went to the emergency department at Kaohsiung Medical University Hospital, where I had an X-ray.
The examination showed no fractures, and the emergency visit ended rather quickly.
However, after returning home, I continued to experience pain that made it difficult to breathe, lift heavy objects, or lie flat, with a tearing sensation.
The next day, I went to Sheng Kung Hospital to check for internal bleeding, but the doctor arranged for another X-ray.
I don’t understand why the area where I was struck and where I feel pain is in the middle of the chest near the ribs, close to the heart, yet the doctor focused the ultrasound on the left flank.
I was only prescribed pain relief.
Today marks a week since the incident, and I still experience pain that prevents me from taking deep breaths.
Breathing or coughing sometimes causes a tearing pain, and if I maintain a fixed position for too long, I feel a sensation as if my internal organs are stuck.
I have been experiencing shortness of breath daily, needing to take deep breaths, and I’m unsure if this is hyperventilation.
Additionally, I sometimes feel palpitations, and sneezing clearly causes internal pain.
I am very concerned about whether coughing or sneezing could worsen my condition.

I would like to ask the doctor:
1.
Under significant impact, if X-rays show no rib fractures and there are no obvious external injuries, could internal organs still be injured? If there is damage to the stomach or diaphragm, could it persist for a week? Is there a possibility of damage to the heart or other organs? What is the observation period?
2.
What symptoms should prompt immediate medical attention?
3.
If a strong man struck me in the area I described, what organs, such as the heart or arteries, could potentially be injured?
4.
Is it possible for severe complications to arise several days after the injury?

Xiao Yu, 30~39 year old female. Ask Date: 2016/01/10

Dr. Li Zhonghuai reply Surgery

Hello! I recommend that you get an ultrasound! A chest ultrasound, cardiac ultrasound, and abdominal ultrasound.
If there are any abnormalities, then a CT scan should be performed, as it can sometimes be difficult to determine.
We have had cases in our hospital where a patient's safety airbag deployed and resulted in pericardial effusion! Changhua Hospital cares about you!

Reply Date: 2016/01/10

More Info

I'm sorry to hear about your situation. It sounds quite distressing, and it's important to address your concerns regarding the trauma you experienced. Based on your description, you sustained a significant impact to your chest, which can lead to various complications, even if initial X-rays did not show any fractures. Here’s a comprehensive response to your questions:
1. Internal Injuries After Trauma: Even if X-rays show no rib fractures, it is still possible to have internal injuries. The ribs protect vital organs, including the lungs, heart, and major blood vessels. A strong blow can cause contusions (bruises) to the lungs or even lead to a pneumothorax (collapsed lung), which may not be immediately evident on an X-ray. Symptoms like difficulty breathing, sharp pain, and a feeling of tightness can indicate underlying issues such as a lung contusion or diaphragm injury. The diaphragm, which separates the chest from the abdomen, can be affected by trauma, leading to pain and difficulty with deep breaths.

2. Symptoms to Watch For: If you experience worsening pain, difficulty breathing, coughing up blood, or any signs of shock (such as rapid heartbeat, confusion, or fainting), you should seek immediate medical attention. Additionally, if you develop a fever, this could indicate an infection or other complications.

3. Potential Organ Damage: The area you described is close to the heart, lungs, and major blood vessels. While rib fractures are a common concern, other injuries can occur, such as bruising of the heart (myocardial contusion) or damage to the aorta. Although these injuries are less common, they can be serious. The risk of injury increases with the force of the impact, and it’s essential to monitor for any new or worsening symptoms.

4. Delayed Complications: It is indeed possible for complications to arise days or even weeks after the initial injury. For instance, a hematoma (a localized collection of blood outside of blood vessels) can develop and cause pressure on surrounding structures, leading to pain and dysfunction. Similarly, a pneumothorax may not present immediately and can develop over time, especially if there was a small tear in the lung tissue.

5. Follow-Up Care: Given that you are still experiencing significant pain and difficulty breathing a week after the injury, it would be prudent to seek further evaluation. A CT scan of the chest may provide more detailed information about any potential internal injuries that X-rays might have missed.
In summary, while initial imaging may not show fractures, the symptoms you are experiencing warrant further investigation to rule out any serious internal injuries. It’s crucial to advocate for your health and seek additional medical opinions if you feel your concerns are not being adequately addressed. Don't hesitate to return to the emergency room or consult a specialist if your symptoms persist or worsen. Your health and well-being are the top priority.

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