Chest Radiography Assessment of Tracheobronchial Disruption Associated with Blunt Chest Trauma

Ruptura traumática de via aérea em criança: um desafio diagnóstico

“…The presence of cyanosis, for example, may also depend of the quantity of intrabronchial blood and on the severity and extension of pulmonary contusion. 15 In the case described here, attention was attracted by dyspnea, stridor and subcutaneous emphysema with rapid onset and progression. The respiratory distress with very early onset might have been due to an accumulation of secretions and/or blood in the airway, injured mucosa or cartilage with interrupted continuity or, even, compression of the airway by mediastinal or subcutaneous emphysema.…”

“…There are several mechanisms involved in airway injuries secondary to thoracic trauma: compression of the thorax with lateral displacement of the lungs, producing traction on the trachea which is fixed to the carina; 14 sudden increase in intraluminal pressure, creating a pressure gradient between the airway lumen and the mediastinum with a rupture close to the carina; 14,15 rapid deceleration producing a pressure difference between fixed and unfixed tissue which lead to torsion of the hilus and rupture of the bronchus close to the carina 14,15 and crushing of the thorax with compression of the airway between the sternum and spine. Knowledge of these pathophysiologic mechanisms is of interest in the sense that it alerts physicians to those injuries that can occur as a result of a thoracic trauma.…”

“…In a series of nine cases of tracheobronchial rupture, Nishiumi et al observed that hemoptysis was present in all patients. 15 Chu & Chen reported that up to 60% of patients with airway trauma presented dyspnea, 69% subcutaneous emphysema, 43% pneumomediastinum and 69% had pneumothorax. 16 Notwithstanding, other associated injuries may contribute to clinical findings.…”

“…In contrast, injuries to the distal airway may not be accompanied by air leakage, as two cases demonstrated. 15 Atelectasis of segments or lobes and pulmonary collapse are other findings that can be associated with airway trauma. Chest tomography can be of help in defining the location of damage.…”

Tracheobronchial Rupture due to Compression Under a Cannon Barrel

“…The presence of pneumomediastinum, pneumothorax, or both may thus be suggested. The presence of bilateral pneumothoraces is more suggestive of tracheal lacerations and distal airway and/or parenchymal tears [2,3,7]. Computed tomography provides enhanced images of anatomical structures, in their retrospective study, Chen et al [8] found only 85% sensitivity for detecting tracheal rupture in fourteen patients with such an injury.…”