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Citation:
Hacking C, Sharma R, Elfeky M, et al. Tracheobronchial injury. Reference article, Radiopaedia.org (Accessed on 23 Apr 2024) https://doi.org/10.53347/rID-45454
Tracheobronchial injury is a serious but uncommon manifestation of chest trauma. It is usually a fatal injury with only a small percentage of patients making it to hospital. Given the magnitude of force required to injure the major airways, there are often multiple chest and other bodily injuries.
The cervical trachea is the most injured site in penetrating injury 3, whereas injury to the distal trachea (within 2.5 cm of the carina) is seen most commonly following blunt chest trauma 4. The site of injury can be identified in 70% of patients with CT 7.
Plain radiograph
CT
Features include 6:
disruption of the tracheal or bronchial cartilage rings
irregularity of the airway wall
focal thickening of the tracheal or bronchial wall
laryngeal disruption
massive pneumomediastinum (sometimes despite appropriate pleural space decompression with intercostal catheters)
fallen lung sign: rare
If left untreated, late complications can occur such as 9:
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1. Kumpe DA, Oh KS, Wyman SM. A characteristic pulmonary finding in unilateral complete bronchial transection. Am J Roentgenol Radium Ther Nucl Med. 1971;110 (4): 704-6. Pubmed citation
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2. Dissanaike S, Shalhub S, Jurkovich GJ. The evaluation of pneumomediastinum in blunt trauma patients. J Trauma. 2008;65 (6): 1340-5. doi:10.1097/TA.0b013e318169cd24 - Pubmed citation
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3. Kaewlai R, Avery LL, Asrani AV et-al. Multidetector CT of blunt thoracic trauma. Radiographics. 2008;28 (6): 1555-70. Radiographics (full text) - doi:10.1148/rg.286085510 - Pubmed citation
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4. Rossbach MM, Johnson SB, Gomez MA et-al. Management of major tracheobronchial injuries: a 28-year experience. Ann. Thorac. Surg. 1998;65 (1): 182-6. Pubmed citation
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5. Pearls and Pitfalls in Emergency Radiology: Variants and Other Difficult Diagnoses. Cambridge University Press. ISBN:110702191X. Read it at Google Books - Find it at Amazon
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6. Karmy-Jones R, Avansino J, Stern EJ. CT of blunt tracheal rupture. AJR Am J Roentgenol. 2003;180 (6): 1670. doi:10.2214/ajr.180.6.1801670 - Pubmed citation
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7. Chen JD, Shanmuganathan K, Mirvis SE et-al. Using CT to diagnose tracheal rupture. AJR Am J Roentgenol. 2001;176 (5): 1273-80. doi:10.2214/ajr.176.5.1761273 - Pubmed citation
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8. Buterbaugh JE, Erly WK. Paratracheal air cysts: a common finding on routine CT examinations of the cervical spine and neck that may mimic pneumomediastinum in patients with traumatic injuries. AJNR Am J Neuroradiol. 2008;29 (6): 1218-21. AJNR Am J Neuroradiol (full text) - doi:10.3174/ajnr.A1058 - Pubmed citation
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9. Chu CP, Chen PP. Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management. Anaesth Intensive Care. 2002;30 (2): 145-52. Pubmed citation
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