Presentation
Drill bit explosion with penetrating neck wound and subcutaneous emphysema.
Patient Data
Penetrating injury of the anterior neck traverses left of midline at the level of the cricoid. The wound tract penetrates the cricothyroid membrane with a metallic foreign body (FB) lodged in the posterior wall of the upper trachea. The superior tip of FB is at the level of the inferior border of cricoid cartilage. No cartilage fractures.
There is extensive emphysema dissecting along fascial planes in the deep spaces of the neck, with inferior extension into the anterior mediastinum.
Vascular structures are intact; no contrast extravasation or focal hematoma.
Metallic foreign body in the posterior wall of the upper trachea.
The thoracic aorta is normal. A small amount of gas tracks from the neck into the anterior mediastinum and adjacent to the trachea.
The lungs are clear apart from a non-specific 3mm nodule in the posterior segment of the right lower lobe.
No vascular injury, hematoma, pneumothorax or fractures.
Removed metallic foreign body. Size: ~0.5cm in length.
Case Discussion
The tracheal foreign body (FB) was endoscopically removed without complication after the patient underwent a tracheostomy to secure the airway.
Penetrating neck injuries often occur secondary to knife or gunshot trauma 1. Rarely, FB at high speeds can penetrate the neck to involve the aerodigestive tract, such as in this case. The entire tract must be imaged as the FB can migrate to other structures and cause devastating vascular injury 1.
Plain radiography may be used to identify radiolucent FB, however, they may not detect FB of lower density or adequately assess soft tissue injury. Computed tomography (CT) is the best method for imaging the extent of soft tissue damage. Angiography may also be needed to specifically assess vascular damage 2.
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