Diagnosis of bronchial rupture with MR imaging

Abstract

Tracheobronchial rupture is a serious injury occurring in approximately 1.5% of cases of major chest trauma. This injury is associated with significant mortality and morbidity and may be difficult to recognize both clinically and radiologically. Radiologic signs are mostly nonspecific, with pneumothorax and pneumomediastinum being the most common. A high level of suspicion is required to make the diagnosis. Computed tomography (CT) can be helpful; however, it provides only indirect evidence for the diagnosis. This report describes a case of complete transection of the right main bronchus, suspected at plain radiography and CT and clearly shown on magnetic resonance (MR) images. MR imaging, with its multiplanar capabilities, can be helpful in defining the location and extent of injury and in diagnosing injury not suspected or clearly demonstrated with other imaging modalities.

CT diagnosis of traumatic bronchial rupture in children

“…There are many indirect radiographic signs of bronchial rupture, including pneumomediastinum, subcutaneous emphysema, pneumothorax, atelectasis, and persistent pneumothorax despite proper chest tube placement [11]. The most specific radiological finding is the ''fallen lung'' sign [11,12,13,14,15], in which the lung falls away from the hilum toward the dependant portion of the hemithorax. This sign is, however, rarely seen.…”

“…This sign is, however, rarely seen. Up to 10% of patients will have no radiographic evidence of major bronchial injury in the immediate post-injury period [11,14].…”

Traumatic Main Bronchial Disruption: Radiologic Evaluation and Surgical Management

“…3,4 Radiologic signs are mostly nonspecific, with pneumothorax and pneumomediastinum being the most common. 1,4 A high level of suspicion is required to make the diagnosis. Nearly all reports recommend that emergency bronchoscopy be carried out in patients with blunt chest trauma having suggestive clinical features to exclude this potentially treatable condition.…”

“…Tracheobronchial rupture is a serious injury occurring in approximately 1.5% of cases of major chest trauma. 1 This rather infrequent type of disruption is often detected as episodical, even in large centers. The clinical picture is not uniform and the correct diagnosis may be delayed.…”