Tracheobronchial injury

Last revised by Liz Silverstone on 14 Dec 2022

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.

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.

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

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

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Cases and figures

  • Case 1
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  • Case 2: blunt trauma
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  • Blunt chest trauma, pulmonary lacerations and bronchial rupture
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