Traumatic Airway Injuries: Role of Imaging

Bagga, Barun; Kumar, Atin; Chahal, Anurag; Gamanagatti, Shivanand; Kumar, Subodh

doi:10.1067/j.cpradiol.2018.10.005

Cited by 16 publications

(19 citation statements)

References 57 publications

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“…If endotracheal intubation is successfully managed, but persistent hypoxaemia without pneumothorax is seen on eFAST examination, we should keep an attention of airway injury [17] . On chest X-ray (CXR) the three typical signs of TBI are subcutaneous emphysema, pneumothorax and pneumomediastinum [1 , 2 , 6 , 12] .…”

Section: Radiologymentioning

confidence: 99%

“…These aforementioned diagnostic tools help the clinicians to suspect airway injury. At this point Bagga et al defined the criterion that may signify the need of an urgent chest computed tomography: 1) hypoxaemia without pneumothorax after endotracheal intubation, 2) massive air leak after tube thoracotomy and persistent pneumothorax, 3) progressive subcutaneous emphysema and pneumomediastinum [17] .…”

Section: Radiologymentioning

confidence: 99%

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Contemporary management strategies of blunt tracheobronchial injuries

Rieth

Barootchi

Kovács

et al. 2021

Injury

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Background: Tracheobronchial injuries are rare but feasibly life-threatening conditions. A prompt diagnosis and early management can be lifesaving. Due to the unspecific symptoms and indirect radiological signs the diagnosis often delays.Objectives: We present a short series of patients suffering from tracheobronchial airway laceration. All the three patients had blunt thoracic or neck trauma and showed early signs of tracheobronchial injury. In the first case a 44-year-old woman was crushed by a bus. Subcutaneous emphysema, pneumothorax on chest computed tomography and hypoxaemia despite of chest tube suggested the presence of an airway injury. During operation a 4-cm-long tear of the trachea and a complete transection of the right main bronchus were found. In the second case a 12-year-old girl was crossed by a truck trailer. Early signs were respiratory failure, extended subcutaneous emphysema, blood clot in the larynx, pneumothorax on both sides. Chest CT showed pneumomediastinum. During the operation a longitudinal laceration was found separating the two main bronchi at the bifurcation. In the third case a 9-year-old boy was injured in a car accident, when the seat-belt crossed his neck. Spreading subcutaneous emphysema, pneumomediastinum and an overinflated endotracheal tube's cuff were found on CT. A completely transected trachea between the first and second tracheal rings was found. All three patients required fast intubation and bronchoscopic examination to confirm the diagnosis, and to identify the site of lacerations. All the patients underwent primary reconstruction and recovered successfully. Conclusions:In case of suspected tracheobronchial injury, a high index of suspicion is required for early diagnosis. Most commonly respiratory distress, subcutaneous emphysema and pneumothorax are found on physical examination. Prompt intubation below the site of the injury and early laryngo-or bronchoscopic examination have priority, as we did in our cases. A primary anastomosis is required with minimal resection during urgent operation. A better outcome is to be expected when extubation is done early after surgery. We offer ordinal steps that should be taken to lead to a prompt management and good long-term outcome based on the literature and our experiences.

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Section: Radiologymentioning

confidence: 99%

Section: Radiologymentioning

confidence: 99%

Contemporary management strategies of blunt tracheobronchial injuries

Rieth

Barootchi

Kovács

et al. 2021

Injury

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“…In our patient, we did not use jet ventilation through the AEC during tube exchange. Additionally, there was no evidence of injury to the tracheobronchial tree or evidence of pneumomediastinum in the postoperative CT; this, however, does not exclude the presence of minor injuries to the tracheobronchial tree, which might not be seen on CT in some cases [34,35].…”

Section: Discussionmentioning

confidence: 88%

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged gentleman who developed right pneumothorax during an elective laparoscopic cholecystectomy. The patient had no risk factors for adverse events during the preoperative assessment (ASA1). The patient underwent general anesthesia and was put on mechanical ventilation. The first signs of abnormality immediately after surgical port insertion were tachycardia and low oxygen saturation in addition to sings of airway obstruction. The diagnosis of pneumothorax was made clinically by chest auscultation and later confirmed by intraoperative chest radiograph. Supportive treatment was started immediately through halting the surgery and manually ventilating the patient using 100% oxygen. Definitive treatment was then done by inserting an intercostal tube. After stabilizing the patient, the surgery was completed; then, the patient was extubated and shifted to the surgical ward. Postoperative computed tomography (CT) scan was done and showed only minimal liver laceration. The patient was discharged after removing the intercostal tube and was stable at the follow-up visit. Therefore, it is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.

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“…Esetleg a trachealis légsáv elmosódása, megszakadása vagy paratrachealis légsáv jelenhet meg. Mindezek alapján a negatív CT nem zárja ki a légcsősérülés lehetőségét [9][10][11]. Segítségünkre lehet a háromdimenziós rekonstrukció vagy a virtuális bronchoszkópia is a diagnózisban.…”

Section: Esetismertetésunclassified

“…A fentiek mellett azonban a légúti sérülések diagnosztikájában a fiberoszkópos vizsgálat az "arany standard" eljárás [9]. Számos előnye van a CT-vizsgálattal szemben: gyors, egyszerű, és pontosabb képet adhat a sérülés helyéről, kiterjedéséről.…”

Section: Esetismertetésunclassified

A túlfújt endotrachealis mandzsetta szerepe a légcsősérülések diagnosztikájában

et al. 2020

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Absztrakt: A tracheobronchialis sérülések ritkák, de életveszélyes állapotot jelenthetnek. Leggyakoribb okaik a nyaki vagy mellkasi, nagy energiájú tompa trauma, a nehéz intubálás vagy az intratrachealis tubus és gyomorszonda együttes viselése. A korai diagnózis és a megfelelő kezelés életmentő lehet, e sérülések felismerése azonban az atípusos tünetek és a súlyos társsérülések miatt gyakran elhúzódik. Típusos esetekben a fizikális vizsgálat során progresszív, kiterjedt subcutan emphysema hívhatja fel rájuk a figyelmet. További nehézséget jelent, hogy a radiológiai jelek nem elég specifikusak, a komputertomográfiás felvételeken pedig a leggyakrabban csupán subcutan emphysema, pneumomediastinum vagy esetenként pneumothorax látható. Cikkünkben három eset kapcsán mutatjuk be a tracheobronchialis sérüléseket – egy baleseti, egy nehéz intubációs légúti sérülés, illetve egy tracheooesophagealis fistula kialakulása során. Az endotrachealis tubus ballonja a tracheafal rupturája mentén mindegyik esetben túlfújhatóvá vált, így a légút falán kívülre terjedt – ez a képalkotó vizsgálatokon láthatóvá is vált. Ez egy ritka, de direkt és egyértelmű jele a légúti sérüléseknek, mely alapján a trachea teljes falvastagságának szakadására lehet számítani. Cikkünkben a túlfújt ballon diagnosztikus jelentőségére szeretnénk rávilágítani. Orv Hetil. 2020; 161(25): 1063–1068.

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Traumatic Airway Injuries: Role of Imaging

Cited by 16 publications

References 57 publications

Contemporary management strategies of blunt tracheobronchial injuries

Contemporary management strategies of blunt tracheobronchial injuries

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

A túlfújt endotrachealis mandzsetta szerepe a légcsősérülések diagnosztikájában

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