A chest contusion, or bruise, is caused by a fall or direct blow to the chest. Car crashes, falls, getting punched, and injury from bicycle handlebars are common causes of chest contusions. A very forceful blow to the chest can injure the heart or blood vessels in the chest, the lungs, the airway, the liver, or the spleen. Pain may be caused by an injury to muscles, cartilage, or ribs. Deep breathing, coughing, or sneezing can increase your pain. Lying on the injured area also can cause pain.