Tracheal laceration - blunt trauma

Case contributed by Dr Bruno Di Muzio

Presentation

Pushed to the ground while playing rugby.

Patient Data

Age: 20 years
Gender: Male
X-ray

Chest radiograph

Pneumomediastinum with associated soft tissue emphysema along the thoracic wall and base of the neck, particularly on the left. The lungs and pleural spaces are clear, no convincing signs of pneumothorax. No subdiaphragmatic gas. No displaced rib fractures. 

CT

CT Chest

CT confirms an extensive pneumomediastinum that tracks through the extrapleural space in the lung apices, bilateral chest walls, and along the deep planes of the imaged neck. No signs of pneumothorax, the lungs and pleural spaces are clear.  An oblique tear causing a step in the tracheal wall is noted distally and on the right; the airways are otherwise normal. Thoracic cage is preserved, no fractures identified. 

CT

Dedicated images

Reconstructions better depicting the tracheal tear on the right. 

Case Discussion

Tracheobronchial tears/lacerations are rarely found in blunt traumas and when occurring, it predominantly happens in the intrathoracic trachea or mainstem bronchi 1,2

Three different mechanisms have been proposed to justify the intrathoracic tracheal tears 1:

  • sudden and vigorous anteroposterior thoracic compression: believed to pull the lungs apart from the carina as a consequence of the increase in the thoracic transverse diameter
  • shearing forces related to rapid deceleration, considering that the carina is relatively fixed 
  • squeezing of the chest while the glottis is closed leading to a sudden rise in the airways internal pressure leading to rupture at the tracheal membranous portion 
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Case information

rID: 59456
Published: 9th Apr 2018
Last edited: 10th Apr 2018
System: Chest
Inclusion in quiz mode: Included

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