Pediatric tracheal injuries: Report on 5 cases with special view on the role of bronchoscopy and management

Gáti, Nikolett; Kassai, Tamás; Prokopp, Tamás; Vizi, András; Hetthéssy, Judit

doi:10.1016/j.injury.2020.02.057

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…Some authors recommend bronchoscopy in patients with SPM, when tracheal injury is suspected. 10 We did not perform this diagnostic possibility, because it was an urgent situation requiring application of decompression. Furthermore, the repeated CT images using virtual bronchoscopy did not reveal any signs of bronchial or tracheal injury.…”

Section: Discussionmentioning

confidence: 99%

Severe Spontaneous Pneumomediastinum in a Girl with Cystic Fibrosis

Zsiborás

Adonyi

Stankovics

et al. 2021

European J Pediatr Surg Rep.

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We report on an 11-year-old girl with cystic fibrosis who presented with thoracic pain and an extensive subcutaneous emphysema and subsequently developed progressive respiratory distress. The chest computed tomography revealed a huge pneumomediastinum. Due to the development of severe respiratory failure, urgent needle thoracocentesis was necessary that resulted in only temporary improvement. Therefore, under general anesthesia two mediastinal drains were introduced. Using active suction, the size of the pneumomediastinum decreased gradually and the drains were removed after 3 weeks. Here, we describe an extremely rare situation, when acute surgical intervention was necessary in a child with spontaneous pneumomediastinum.

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Section: Discussionmentioning

confidence: 99%

Severe Spontaneous Pneumomediastinum in a Girl with Cystic Fibrosis

Zsiborás

Adonyi

Stankovics

et al. 2021

European J Pediatr Surg Rep.

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“…Bronchoscopy/fiberoptic endoscopy has been the gold standard for definitive diagnosis of TBIs and can serve as a useful tool not only to allow locating the injury but also provide adequate ventilation by adjusting the position of the endotracheal tube or even undertaking immediate management of minor tears with tissue adhesives [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…As our patient was clinically stable, did not require supplemental oxygen or mechanical ventilation throughout his hospitalisation, and a small tear was visualised with cross-sectional imaging, it was deemed unnecessary to proceed with endoscopy as it would not alter the management at the time. Gati et al noted that in some cases bronchoscopy failed to confirm the diagnosis of small TBIs found on a CT scan and suggested that, even though endoscopy is recommended for early diagnosis, close observation following an imaging-based diagnosis can be considered based on clinical assessment [ 4 , 6 ]. It is important to provide care in the appropriate environment, that is, tertiary paediatric centre, high dependency unit, or intensive care unit, depending on the patient’s clinical condition.…”

Section: Discussionmentioning

confidence: 99%

“…Their proposed treatment included broad-spectrum antibiotics and anti-inflammatory aerosols [ 9 , 10 ], while our patient received a course of broad-spectrum antibiotics and steroids (intravenous dexamethasone). Small tears requiring intubation could be managed with a cuff being placed distal to the site of the injury or selective bronchial intubation [ 3 , 6 , 11 ]. The use of extracorporeal membrane oxygenation was also reported as a means to provide cardiorespiratory support in paediatric patients who sustained blunt trauma to the chest [ 1 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prompt diagnosis and management of TBI are crucial for a patient’s prognosis, which can be especially challenging in polytrauma cases [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Paediatric Longitudinal Tracheal Laceration From Blunt Force Trauma: A Case Report

Loroch¹,

Curran²,

Wynne³

2021

Cureus

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Tracheal lacerations in the paediatric population are not common; however, they can be life-threatening. Prompt diagnosis and management are essential for a good prognosis. Here, we present the case of a nine-year-old boy who presented to the hospital following a bicycle handlebar injury with neck pain and subcutaneous emphysema of the anterior thorax and neck. Chest X-ray revealed pneumomediastinum and a small pneumothorax. A computed tomography scan revealed a posterior longitudinal laceration of the trachea, measuring 1.5 cm, located superior to the carina at T1/2. As the patient was clinically stable, did not require any supplemental oxygen, and the tear was smaller than 2 cm, conservative management with steroids and broad-spectrum antibiotics was implemented. The patient was transferred to a tertiary ENT centre in Glasgow for observation in the paediatric intensive care unit where he recovered uneventfully. A repeat cross-sectional imaging six days after the injury revealed successful healing of the laceration. Non-surgical management of a tracheobronchial injury can be an effective approach. This can be considered in the case of tears measuring <2 cm and in clinically stable patients. Imaging-based diagnosis in the case of patients with minor injuries who are improving with conservative treatment may be sufficient, and confirmation with bronchoscopy would be of questionable clinical value in such patients.

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