Traumatic airway disruption in a child: a diagnostic challenge

Abstract

Objective: To report a case of airway disruption in a child victim of blunt thoracic trauma due to falling off a sink.Description: Descriptive case report. A 34-month old boy victim of thoracic trauma was seen at the pediatric intensive care unit of a university hospital. Plain chest radiograph, thoracic computed tomography, bronchoscopy, thoracotomy, antibiotics, hemodynamic and respiratory support were performed. Plain chest radiograph, thoracic computed tomography and bronchoscopy were performed in order to arrive at a precise diagnosis of traumatic airway disruption associated with pulmonary contusion, pneumothorax, mediastinal and subcutaneous emphysema. The patient underwent thoracotomy for surgical repair of an almost complete disruption of the left main bronchus. Antibiotics and ventilatory support contributed to a favorable outcome without medium-term sequelae.Comments: Children presenting with thoracic trauma must be investigated for uncommon, but potentially lethal injuries, such as tracheobronchial disruption, particularly in cases where there is strong clinical evidence. Diagnostic workup should be optimized with plain chest radiograph and thoracic computed tomography, while bronchoscopy will confirm the definitive diagnosis. J Pediatr (Rio J)

Experience of diagnosis and treatment of traumatic bronchial rupture in children in a single clinical center

“…(2) The condition of the acute stage of trauma is unstable; thus, it is not suitable for fiberoptic bronchoscopy. 3The clinical manifestations of traumatic bronchial rupture in children are mostly mild shortness of breath, if the child's condition is complicated by other organ damage, bronchial rupture is more likely to be ignored [10][11][12][13][14]. Therefore, to avoid missed diagnosis and delayed diagnosis, it is necessary to be aware of the occurrence of traumatic bronchial rupture in children after trauma, shortness of breath or dyspnea, subcutaneous emphysema of neck and chest, tension pneumothorax, and a persistent large amount of air leakage after closed drainage of the chest [15].…”