Among patients suffering chest blunt trauma, tracheo-bronchial injury is rare, occurring in only 0.8–2% of cases. In addition, tracheal or bronchial rupture can be determined by intubation manoeuvre and post-intubation injuries. Also penetrating injuries to the neck and thorax are often the cause of a tracheo-bronchial tear. However, high speed traffic accidents are the most frequent cause of tracheal and bronchial injuries.
Depending on the depth of damage, a wide spectrum of lesions may occur and can determine, as consequence, a mucosal-tracheal stenosis, tracheo-malacia and full-thickness stricture.
Tracheal rupture is associated with a higher morbidity and mortality.
It is supposed that 50% of patients die at the trauma scene from severe respiratory insufficiency or other associated injuries, especially significant thoracic cage harm, lung lacerations and thoracic aorta tear. In patients that survive, airway injuries have an overall mortality rate of 30%.
Most major airway injuries are not recognized early. Diagnosis of tracheal rupture may be delayed as a result of its rare incidence, subtle and non-specific clinical and radiological manifestation and for the presence of additional clinical findings of other more common associated injuries of the chest, the abdomen and the brain.
A significant number of cases are undiagnosed until complications develop either at the site of rupture, such as bronchial stenosis or dilatation, or in the lung distal to the rupture, such as atelectasis and recurrent infections.
In fact, in two thirds of airway injuries, the diagnosis is delayed with subsequent high morbidity for serious complications, such as recurrent pneumonia, empyema, pulmonary abscesses, mediastinitis, airway obstruction and atelectasis.
Generally, the most frequent symptoms of all blunt airway injuries are dyspnoea (76–100%), hoarseness (46%), subcutaneous emphysema (35–85%) and haemoptysis (14–25%).
Pain associated with swallowing and skin contusion, neck emphysema, pneumo-mediastinum and hoarseness are clinical findings that can allow to suspect the diagnosis.
Other symptoms are dyspnoea, cough, bloody saliva, haemoptysis and dysphagia. These symptoms are frequently associated with physical features as cyanosis, pneumothorax, vocal cord paralysis, aphonia and subcutaneous emphysema diffused also into shoulders and chest fat planes.
CT is considered the more relevant diagnostic tool in patients with blunt chest trauma, following the basic and essential chest X-ray film. CT can clearly demonstrate the fat planes, vessels, larynx, trachea, bronchus and oesophagus traumatic lesions, and it is the most important preoperative diagnostic imaging modality for determining the location, extent and type of airway lesions.
KeywordsBlunt thoracic trauma Cervical trachea injury Mediastinal trachea tear Airway traumatic injury Tracheo-bronchial disruption Intubation manoeuvre airway injury Tracheo-bronchial partial lesions Post-intubation tracheal stenosis
- 4.Glinjongol C, Pakdirat B. Management of tracheobronchial injuries: a 10 year experience at Ratchaburi Hospital. J Med Assoc Thail. 2005;88:32–40.Google Scholar
- 13.Valerio P, Ivan M, Francisco R, et al. Survival after traumatic complete laryngotracheal transection. Am J Emerg Med. 2008;26(837):e3–4.Google Scholar