<prompt> Thoracotomy is indicated in all the following exceptPenetrating chest injuriesRapidly accumulating haemothoraxMassive air leakPulmonary contusion  <response>: Ans. d Pulmonary contusion. Ref. Bailey Love, Short Practice of Surgery, 25thpg. 341CHEST INJURIES Directly or indirectly involved in 50 of trauma deaths in the USA About 80 of chest injuries can be managed closed A chest radiograph is the investigation of first choice A spiral CT scan provides rapid diagnosis in the chest and abdomen A chest drain can be diagnostic as well as therapeutic If there is an open wound insert a chest drain Do not close a sucking chest wound until a drain is in place If bleeding persists, the chest will need to be opened. One of the most vital parts of management of patient with chest trauma is to identify any threat to life mentioned below. These are surgical emergencies operative treatment required.Immediately life threatening injuriesPotentially life threatening injuries Airway obstruction Aortic injuries Tension pneumothorax Tracheobronchial injuries Pericardial tamponade Myocardial contusion Open pneumothorax Rupture of diaphragm Massive haemothorax Oesophageal injuries Flail chest Pulmonary contusion 