Tears of the trachea and main bronchi caused by blunt trauma: radiologic findings

Abstract

Although most of the radiologic changes that have been described in transection or laceration of the trachea or main bronchi are nonspecific, they can be of diagnostic importance in the appropriate clinical setting. In order to reassess the significance of these findings, and to determine the presence of any other changes that might lead to a definitive diagnosis, we retrospectively reviewed the chest radiographs of nine patients who had tears or transection of the trachea and/or main bronchi as a result of blunt chest trauma. The diagnosis was proved by bronchoscopy in all patients and reconfirmed at surgery in five. The predominant findings on the chest radiographs were related to air leak and included subcutaneous emphysema (seven patients), pneumomediastinum (seven patients), pneumothorax (six patients), and air surrounding a bronchus in one patient. Upper thoracic fractures that involved the clavicles, scapula, sternum, and ribs were present in four patients. Abnormalities in the appearance of an endotracheal tube in two patients (overdistention of the cuff or extraluminal position of the tip), and the presence of the fallen lung sign (collapse of the lung toward the lateral chest wall) in two others provided specific evidence of tracheobronchial injury. We conclude that, although the major importance of the chest radiograph in patients with tracheobronchial transection may be to verify the existence of air leak, the presence of the fallen lung sign and endotracheal tube abnormalities is a reliable indication of airway injury.

Blunt thoracic trauma in children: review of 137 cases

“…Justifications for operative stabilization were pain and respiratuar difficulty. Imaging findings associated with such injury in addition to the air leak include subcutaneous air in the neck, discontinuity of the tracheal wall, abnormal endotracheal tube position, or the fallen lung sign, which is defined as collapse of the involved lung away from the hilum [14,15]. Flexible endoscopy nearly always provides a definitive diagnosis [16].…”

CT diagnosis of traumatic bronchial rupture in children

“…There are many indirect radiographic signs of bronchial rupture, including pneumomediastinum, subcutaneous emphysema, pneumothorax, atelectasis, and persistent pneumothorax despite proper chest tube placement [11]. The most specific radiological finding is the ''fallen lung'' sign [11,12,13,14,15], in which the lung falls away from the hilum toward the dependant portion of the hemithorax. This sign is, however, rarely seen.…”

Pneumothorax and parenchymal cavitation caused by airway injury after blunt trauma to the chest

“…Although the diagnosis of tracheobronchial laceration can be proven by bronchoscopy, surgical confirmation may be necessary in some patients, especially those having laceration of the segmental bronchi (1,2). A possible reason to explain why we were unable to identify an injury at bronchoscopy may be attributable to the injury affecting the more distal segmental or subsegmental airways rather than the main or lobar bronchi.…”

“…Cervicothoracic subcutaneous emphysema, pneumomediastinum and pneumothorax are the most obvious findings in airway injuries due to blunt trauma (1). Although these findings are generally associated with rib fracture in the acutely traumatized patient, rib fracture is uncommon in children and young adults due to the greater resilience of the thoracic cage.…”