Pulmonary contusion, a common consequence of blunt chest trauma, exhibits a mortality and prognostic profile strongly linked to its severity. This article synthesizes current knowledge on the pathophysiological mechanisms of pulmonary contusion, encompassing lung tissue damage, cellular and cytokine responses, arachidonic acid metabolites, reactive oxygen species, the complement system, and the coagulation cascad. By elucidating this complex inflammatory network, we aim to bridge fundamental research with clinical practice. Furthermore, we summarize recent advances in understanding these mechanisms and discuss emerging treatment strategies that target them, with the ultimate goal of improving patient outcomes through timely intervention.