Blast Lung Injury
Definition
Bilateral pulmonary contusion and alveolar tear from primary blast overpressure. The most lethal primary blast mechanism. Characterised at autopsy by bilateral 'butterfly' distribution haemorrhage, alveolar tear on microscopy, and frequent haemopneumothorax. No external wound. Identified in the JTTR dataset at 2.6% incidence with 28% mortality among US military blast casualties.
- Mechanism
- Primary blast overpressure, bilateral pulmonary contusion
- Autopsy finding
- Bilateral 'butterfly' distribution haemorrhage
- Microscopy
- Alveolar tear
- Incidence/mortality (JTTR)
- 2.6% incidence, 28% mortality among affected
Common questions
Why can blast lung injury be present with no visible external wound?+
The overpressure wave transmits through the chest wall and damages the air-fluid interfaces within the lung tissue itself, so the destructive mechanism is internal and can occur without any penetrating or externally visible injury, which is why it is easy to miss without a targeted autopsy examination.
Why is blast lung injury considered the most lethal primary blast mechanism?+
It disrupts gas exchange directly and can cause rapid respiratory failure or air embolism, and because it leaves no external sign, it can be under-recognised in triage compared with more visible injuries, contributing to its high mortality rate among those affected.
Related terms
- Primary Blast Injury
- Injury caused directly by the overpressure (blast) wave. Preferentially affects gas-containing organs (lungs, tympanic membranes, bowel). Blast lung (alveolar haemorrhage, barotrauma) is...
- Quaternary Blast Injury
- All blast-related injury not in primary/secondary/tertiary classes: burns (flash fireball + secondary fire), crush (structural collapse), and inhalation injury (CO, HCN, particulate)....
- Secondary Blast Injury
- Penetrating injury from fragments: device casing metal, pre-formed projectiles (nails, bolts, BBs), or environmental debris accelerated by the blast wave. The most...
- STANAG 2920
- NATO Standardization Agreement 2920, defining the fragmentation injury threshold for ballistic protection standards. Relevant in blast forensic pathology for relating fragment mass...
- Tertiary Blast Injury
- Blunt-force injury caused by physical displacement of the victim's body by the blast wind, followed by impact against surfaces. Morphologically identical to...
- Tympanic Membrane Perforation (TMP)
- Rupture of the eardrum by blast overpressure, occurring at 35-103 kPa, well below the threshold for blast lung injury. The most sensitive...