Tracheobronchial injury

Changed by Mostafa Elfeky, 2 Jan 2024
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Disclosures - updated 14 May 2023: Nothing to disclose

Updates to Article Attributes

Body was changed:

Tracheobronchial injury is a serious but uncommon manifestation of chest trauma. It is usually a fatal injury with only a small percentage of patients making it to hospital. Given the magnitude of force required to injure the major airways, there are often multiple chest injuries and other body regions affected.

Pathology

The cervical trachea is the most injured site in penetrating injury 3, whereas injury to the distal trachea (within 2.5cm of the carina) is seen most commonly following blunt chest trauma 4. The site of injury can be identified in 70% of patients with CT 7.

Radiographic features

Plain radiograph
CT

Features include 6:

  • disruption of the tracheal or bronchial cartilage rings
  • irregularity of the airway wall
  • focal thickening of the tracheal or bronchial wall
  • laryngeal disruption
  • massive pneumomediastinum (sometimes despite appropriate pleural space decompression with intercostal catheters)
  • fallen lung sign (first described in 1970 1): rare rare

Complications

If left untreated, late complications can occur such as 9:

Differential diagnosis

  • -<p><strong>Tracheobronchial injury</strong> is a serious but uncommon manifestation of chest trauma. It is usually a fatal injury with only a small percentage of patients making it to hospital. Given the magnitude of force required to injure the major airways, there are often multiple chest injuries and other body regions affected.</p><h4>Pathology</h4><p>The cervical trachea is the most injured site in penetrating injury <sup>3</sup>, whereas injury to the distal trachea (within 2.5cm of the carina) is seen most commonly following blunt chest trauma <sup>4</sup>. The site of injury can be identified in 70% of patients with CT <sup>7</sup>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul>
  • -<li>
  • -<a href="/articles/subcutaneous-emphysema">subcutaneous emphysema</a> in the chest and/or neck</li>
  • -<li><a href="/articles/pneumothorax">pneumothorax</a></li>
  • -<li><a href="/articles/pneumomediastinum">pneumomediastinum</a></li>
  • -<li>endotracheal tube balloon<ul>
  • -<li>overinflation</li>
  • -<li>abnormal shape</li>
  • -<li>herniation into the airway defect</li>
  • -</ul>
  • -</li>
  • -</ul><h5>CT</h5><p>Features include <sup>6</sup>:</p><ul>
  • -<li>disruption of the tracheal or bronchial cartilage rings</li>
  • -<li>irregularity of the airway wall</li>
  • -<li>focal thickening of the tracheal or bronchial wall</li>
  • -<li>laryngeal disruption</li>
  • -<li>massive pneumomediastinum (sometimes despite appropriate pleural space decompression with intercostal catheters)</li>
  • -<li>
  • -<a href="/articles/fallen-lung-sign">fallen lung sign</a> (first described in 1970 <sup>1</sup>): rare</li>
  • -</ul><h4>Complications</h4><p>If left untreated, late complications can occur such as <sup>9</sup>:</p><ul>
  • -<li>recurrent infection (<a href="/articles/pneumonia">pneumonia</a>)</li>
  • -<li>bronchial or <a href="/articles/tracheal-stenosis">tracheal stenosis</a>
  • -</li>
  • -<li><a href="/articles/bronchiectasis">bronchiectasis</a></li>
  • -</ul><h4>Differential diagnosis</h4><ul><li>
  • -<a href="/articles/tracheal-diverticulum">tracheal diverticulum</a>: usually on the right and at the level of the <a href="/articles/superior-thoracic-aperture">superior thoracic aperture</a> <sup>8</sup>
  • +<p><strong>Tracheobronchial injury</strong> is a serious but uncommon manifestation of chest trauma. It is usually a fatal injury with only a small percentage of patients making it to hospital. Given the magnitude of force required to injure the major airways, there are often multiple chest injuries and other body regions affected.</p><h4>Pathology</h4><p>The cervical trachea is the most injured site in penetrating injury <sup>3</sup>, whereas injury to the distal trachea (within 2.5cm of the carina) is seen most commonly following blunt chest trauma <sup>4</sup>. The site of injury can be identified in 70% of patients with CT <sup>7</sup>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul>
  • +<li>
  • +<a href="/articles/subcutaneous-emphysema">subcutaneous emphysema</a> in the chest and/or neck</li>
  • +<li><a href="/articles/pneumothorax">pneumothorax</a></li>
  • +<li><a href="/articles/pneumomediastinum">pneumomediastinum</a></li>
  • +<li>endotracheal tube balloon<ul>
  • +<li>overinflation</li>
  • +<li>abnormal shape</li>
  • +<li>herniation into the airway defect</li>
  • +</ul>
  • +</li>
  • +</ul><h5>CT</h5><p>Features include <sup>6</sup>:</p><ul>
  • +<li>disruption of the tracheal or bronchial cartilage rings</li>
  • +<li>irregularity of the airway wall</li>
  • +<li>focal thickening of the tracheal or bronchial wall</li>
  • +<li>laryngeal disruption</li>
  • +<li>massive pneumomediastinum (sometimes despite appropriate pleural space decompression with intercostal catheters)</li>
  • +<li>
  • +<a href="/articles/fallen-lung-sign">fallen lung sign</a> (first described in 1970 <sup>1</sup>):&nbsp;rare</li>
  • +</ul><h4>Complications</h4><p>If left untreated, late complications can occur such as <sup>9</sup>:</p><ul>
  • +<li>recurrent infection (<a href="/articles/pneumonia">pneumonia</a>)</li>
  • +<li>bronchial or <a href="/articles/tracheal-stenosis">tracheal stenosis</a>
  • +</li>
  • +<li><a href="/articles/bronchiectasis">bronchiectasis</a></li>
  • +</ul><h4>Differential diagnosis</h4><ul><li>
  • +<a href="/articles/tracheal-diverticulum">tracheal diverticulum</a>:&nbsp;usually on the right and at the level of the <a href="/articles/superior-thoracic-aperture">superior thoracic aperture</a> <sup>8</sup>
Images Changes:

Image 4 CT (non-contrast) ( update )

Caption was added:
Case 3: blunt chest trauma

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