A reliable early symptom of bronchial or tracheal rupture

Eijgelaar, A; Heide, J. N. Homan van der

doi:10.1136/thx.25.1.120

Cited by 43 publications

(11 citation statements)

References 6 publications

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“…4,9 Deep cervical surgical emphysema is a reliable early sign, 9 and pneumothorax contralateral to the side of injury is also well recognized. 9,10 The diagnostic modality of choice is either rigid or flexible fiberoptic bronchoscopy; 9,10 a rigid bronchoscope allows better maintenance and control of the airway and offers the ability to suck out clotted blood so that the injury can be identified. In older children with larger caliber airways, a flexible bronchoscope can be used through the lumen of an endotracheal tube.…”

Section: Discussionmentioning

confidence: 99%

Delayed Repair of Bronchial Avulsion in a Child through Median Sternotomy

Beale

Bowley

Loveland

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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A 3-year-old girl presented with blunt compression injury to the thorax. Her left lung was initially aerated and she appeared to recover after right pleural cavity tube drainage alone. She presented 4 months later with a total white-out of the left lung; avulsion of the left main bronchus was diagnosed and repaired successfully. The diagnosis of bronchial injury was missed initially, as the initial pneumothorax was contralateral and the ipsilateral lung remained aerated despite complete bronchial disruption. The traditional surgical approach for these injuries has been lateral thoracotomy for both emergency and later repair; however, median sternotomy afforded excellent exposure for elective repair. CASE REPORTA 3-year-old girl sustained a compression injury to her chest when a water boiler fell on top of her. On arrival, she was fully conscious and hemodynamically stable but with noisy respiratory distress and extensive surgical emphysema of the neck and right anterior chest wall and decreased air entry over the right hemithorax. The initial chest radiograph revealed a right hemopneumothorax and pneumomediastinum ( Fig. 1). A right-sided intercostal drain was inserted, with reexpansion of the right lung and resolution of the surgical emphysema. The drain was removed 2 days later and she was discharged from the hospital apparently well. Four months later, she presented complaining of persistent dyspnea, malaise, and a nonproductive cough. Chest radiography showed a white-out on the left (Fig. 2) and a computed tomographic scan confirmed complete left pulmonary atelectasis. Bronchoscopy revealed total occlusion of the origin of the left main bronchus flush with the carina. Through a median sternotomy, the carina was exposed and the origin of the left main bronchus was found distracted laterally. The scarred strictures of both ends were excised and the endotracheal tube was advanced into the right main bronchus to allow comfortable reanastomosis after suction of the left bronchial tree. Anastomosis was with interrupted 4-0 polydioxanone sutures, with all knots placed extraluminally. Ventilatory support was required for 9 days and the left lung reexpanded gradually. When reviewed after 3 months, the child was well and the left lung was fully expanded (Fig. 3). DISCUSSIONThoracic injury is the second leading cause of death after childhood trauma, and the presence of thoracic injury in addition to other injuries in a child increases the probability of death three to four times. 1 The pliability of the chest wall in children allows transmission of massive external forces without disrupting the integrity of the chest wall. Significant intrathoracic injuries such as major pulmonary contusion or tracheobronchial disruption can be present with little external evidence of injury; 2 therefore, a high index of suspicion must be maintained to diagnose serious injury. Mortality rates of up to 30% have been reported for children with tracheobronchial rupture, and approximately half of children who die as a result of this injury ...

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Section: Discussionmentioning

confidence: 99%

Delayed Repair of Bronchial Avulsion in a Child through Median Sternotomy

Beale

Bowley

Loveland

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…Sudden blunt trauma to the front of the chest may cause tracheal and bronchial lacerations and may result in mediastinal emphysema (Olson, 1971;Schiinberg, 1912;Eijgelar, 1970). An erroneous intubation for mechanical ventilation underneath the fascia pretrachealis has resulted in mediastinal emphysema has been reported by Rubio and colleagues 1982.…”

Section: Discussionmentioning

confidence: 99%

The Anatomy of Lamina Pretrachealis Fasciae Cervicalis

Çavdar

Krause²,

Dalçik

et al. 1996

Okajimas Folia Anatomica Japonica

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Summary: The definitions concerning the fascia pretrachealis is either contradictory or insufficient in anatomy textbooks. The fascia pretrachealis is clinically important in the procedure of tracheostomy, mediastinascopy and also in tracheal and bronchial trauma. The anatomy of the fascia pretrachealis (extension, relation and the attachments) was reexamined using cadaveric preparations and the clinical value of the fascia is reinforced. The fascia pretrachealis is attached to the upper brim and to the oblique line of the thyroid cartilage and continued its course on the anterior surface of the trachea and fused with the advantitia of arch of the aorta, posterior aspect of pulmonary artery and the pericardium.Laterally it is attached to the cartilagenous part of the trachea. Also contraversial literature concerning description of the fascia pretrachealis has been evaluated.

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“…The infrequency of presentation of airway trauma may relate to the lethal potential of such injuries. At a major North American trauma centre, 78% of patients with tracheobronchial injuries were dead on arrival 8 , while another series reported a 21% mortality in the first two hours 9 .…”

Section: Discussionmentioning

confidence: 99%

Upper airway trauma

Little

1995

Emergency Medicine

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Twelve cases of injury to the upper airway due to external trauma seen over a seven year period in the emergency department are presented. Four injuries resulted from penetrating trauma and eight from blunt trauma. Active airway management was initially required in seven patients. Two patients died of severe neurological injury despite appropriate airway management. Surgical intervention was undertaken in five of the ten survivors, with good results. One patient was discharged with a tracheostomy. All patients presented with symptoms or signs of airway injury. However, airway injuries are uncommon, patients may present without signs or symptoms and these injuries may be overlooked, with potentially disastrous consequences. Airway trauma should be suspected in all cases of blunt or penetrating trauma to the head, neck or chest. Emphasis should be placed on control of the airway and judicious performance of diagnostic procedures, followed by surgical repair where indicated.

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A reliable early symptom of bronchial or tracheal rupture

Cited by 43 publications

References 6 publications

Delayed Repair of Bronchial Avulsion in a Child through Median Sternotomy

Delayed Repair of Bronchial Avulsion in a Child through Median Sternotomy

The Anatomy of Lamina Pretrachealis Fasciae Cervicalis

Upper airway trauma

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