An 18-year-old driver in a high-speed motor vehicle accident sustained multiple life-threatening injuries, including partial transection of his descending aorta along with a linear tear of the distal trachea. Other significant injuries included closed-head shear injury and multiple bone fractures. Initial presentation revealed a pneumothorax and widening of the mediastinum. Bronchoscopy revealed a long, linear tear of the membranous trachea. Simultaneous exposure of both injuries for repair was not possible. A covered tracheal stent was placed, isolating and sealing the tracheal injury. The aorta was subsequently repaired during cardiopulmonary bypass at a later time. The tracheal stent was removed without sequelae after adequate healing of the membranous tracheal injury. (J Bronchol 2006;13:32-34) T his case describes the nonsurgical management of a blunt tracheal injury. Open surgical repair was not possible as a result of a concomitant extensive major vascular disruption. Proposed surgical repair of the tracheal injury would potentially have caused fatal uncontrollable exsanguination by disruption of a stable hematoma of the descending aorta. An Ultraflex (Boston Scientific, Natick, MA) covered tracheobronchial stent was placed to seal and isolate the tracheal injury, allowing eventual repair of the aortic disruption. We believe this is the first report of managing blunt tracheal injury by stent placement than by surgical repair because of the concomitant major aortic injury.
CASE REPORTAn 18-year-old male, unrestrained driver was involved in a high-speed, head-on collision with a second car. On transfer to the emergency room, he was found to be somnolent but arouseable. Vital signs revealed a blood pressure of 90/70 mm Hg, heart rate 120 beats/min, with a SaO 2 of 90% on 4 L nasal cannula oxygen. Initial survey revealed absent left-sided breath sounds, normal heart sounds, and a soft abdomen. Plain x-rays revealed a widened mediastinum, multiple bilateral rib fractures, and a left pneumothorax. A chest tube was placed. A computed tomography scan was performed revealing mediastinal emphysema (Fig. 1) with a persistent left-sided pneumothorax. Aortic disruption with hematoma was noted adjacent to the origin of the left subclavian artery. There was no evidence of contrast extravasation.The patient was taken to the operating room for planned thoracotomy and interposition grafting of his aortic injury. Because the patient had a persistent pneumothorax with active air leak, bronchoscopic examination of the trachea and distal airways was performed through a single-lumen endotracheal tube. A long, linear, 4-cm tear of the membranous trachea-cartilaginous ring junction was seen on the left, distally, extending to the carinal spur.Initial surgical plans for aortic repair were abandoned because there were no surgical options for combined airway and vascular repair. Exposure for repair of the airway injury would have required contralateral thoracotomy with potential disruption of the aortic hematoma. Instead, after fl...
