DIAGNOSIS OF TRAUMATIC INJURIES OF TRACHEA.

PRESENTED BY MARK ROSEMARY

Physical Exam Findings

Dyspnea Cough� Hemoptysis� Cyanosis� Cervical subcutaneous emphysema� Tracheal shift� Mediastinal emphysema� Signs of airway obstruction�

IMAGING

Initial diagnosis via Chest X-Ray: pneumothorax, pneumomediastinum, subcutaneous emphysema.

Followed up with: Chest CT with and without contrast, � Fiberoptic Bronchoscopy and virtual bronchoscopy (It involves using computed tomography (CT) images of the chest to generate a 3-dimensional model of the walls of the trachea and bronchi. This non-invasive method that allows to see small masses and areas of narrowing in the passages without having to do surgery or pass a tube through them)

Rule out esophageal injury!!�

CXR

Chest radiography is the standard initial screening examination for evaluation of most chest conditions, including possible tracheobronchial injury. Semi-upright chest x-ray with the white arrows

indicating mediastinal air and neck emphysema

CT

•CT is preferred if tracheobronchial tear is suggested.

•Definitive diagnosis of tracheobronchial tear is made by bronchoscopy or surgical exploration.

•If clinical or radiographic findings suggest airway injury, diagnostic bronchoscopy is recommended.

Partial tracheal rupture after a fall from a height of 8 meters.A CT longitudinal section with visible mediastinal emphysema (arrows).

CT

Partial tracheal rupture after a fall from a height of 8 meters.

Section through the trachea with rupture of the membranous portion of the trachea (CT)

BRONCHOSCOPYTracheal rupture after endotracheal intubation 

Diagnostic bronchoscopy revealing a linear laceration of 3-4cm in length on posterior membranous wall of mid-trachea.

Blunt Traumatic Tracheal Laceration Bronchoscopic view of the repair at 2 weeks.

PT & PM

In the most severely injured patients, the airway separates completely at the site of injury with a visibly obvious distortion of tracheobronchial anatomy.

Pneumothorax and/or pneumomediastinum usually are present in these extensive injuries. The location of the tear is important in determining whether pneumomediastinum or pneumothorax develops:

Tears within the mediastinal pleura cause a pneumomediastinum;

Tears beyond the mediastinal pleura cause a pneumothorax.

Note that in severe injuries, both pneumomediastinum and pneumothorax may be present. A pathognomonic indication of tracheobronchial tear, the fallen lung sign, is visible in some patients with severe injury.