An interesting case report from this institution is presented as well. A Medline search of the English literature of delayed presentation of tracheobronchial injuries over the past 10 years was performed. [ncbi.nlm.nih.gov]

Get expert guidance on how to approach specific clinical presentations in the ER. [books.google.com]

Note that in severe injuries, both a pneumomediastinum and a pneumothorax may be present. [emedicine.com]

• Collapse

  Injuries with absence of these features together with collapse of the lung and consequent low arterial oxygen tension while on PPV are less well recognised. [ncbi.nlm.nih.gov]

  Occasionally, an abnormal course of a mainstem bronchus or a “fallen lung” sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury [doi.org]

  Note the caliber change in the right main bronchus relative to the left, persistence of a large right pneumothorax despite chest tube placement, and lateral-inferior collapse of the detached right lung away from its hilum. [radiologykey.com]

  In a person lying face-up, the lung collapses toward the diaphragm and the back. [en.wikipedia.org]

  After repair it allowed ventilation of both lungs and helped us in finding an air leak at the surgical sight and allowed complete expansion of the collapsed lung. [ejca.eg.net]

• Falling

  Peter Tilney, A Tracheal Disruption in an 89-Year-Old Female after a Fall, Air Medical Journal, 30, 4, (173), (2011). [doi.org]

  MVC, fall, airplane crash), complaints of chest pain, dyspnea, hoarseness (frequently absent) - Decreased femoral pulses, differential arm BP (arch tear) - CXR, CT scan, transesophageal echo (TEE), aortography (gold standard) - see below for CXR features [fprmed.com]

  Other potential causes are falls from high places and injuries in which the chest is crushed. Explosions are another cause.Gunshot wounds are the commonest form of penetrating trauma that cause TBI. [en.wikipedia.org]

  With complete laceration of the main bronchus, the bronchus may become partially or completely detached, allowing the lung to fall into a dependent lateral position and producing the fallen-lung sign. [emedicine.com]

  Majority of cases was referred because of blunt trauma in 15 cases (46.8%), 6 (18.75) motor vehicle accident, 5 (15.6%) fall from a height and 4 (12.5%) with trauma by heavy object, while 8 cases (25%) were referred due to penetrating injury and 2 cases [file.scirp.org]

• Swelling

  The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. [ncbi.nlm.nih.gov]

  All surrounding of the neck was tender, swelling and included abrasions (Figure 1a,1b). Crepitus was determined on the anterior-superior of left shoulder. The thyroid and cricoid cartilage landmarks appeared normal on inspection. [austinpublishinggroup.com]

  This can lead to edema (swelling), necrosis (death of the tissue), scar formation, and ultimately stenosis. However, TBI due to inhalation, foreign body aspiration, and medical procedures is uncommon. [en.wikipedia.org]

• Hemoptysis

  Patients apply to emergency department (ED) with Stridor, subcutaneous emphysema, hemoptysis, pneumothorax, severe respiratory distress, hoarseness and pneumomediastinum [3]. [austinpublishinggroup.com]

  In initially diagnosed group, the predominant clinical signs that give a suspicion of tracheobronchial disruption were increased subcutaneous surgical emphysema, shortness of breath, hemoptysis. [file.scirp.org]

  Mortality among survivors who reach the hospital may be as high as 30%. [9] The signs and symptoms among patients of TBI vary based on the location and severity of injury and include dyspnea (76-100%), hemoptysis (25%) [10] dysphonia, coughing, and abnormal [annals.in]

  Other physical and radiological findings often described in the literature, as well as in our patients, are hemoptysis, shock, cyanosis, pneumothorax, hemothorax, rib fractures and pulmonary contusion. [doi.org]

• Stridor

  Patients apply to emergency department (ED) with Stridor, subcutaneous emphysema, hemoptysis, pneumothorax, severe respiratory distress, hoarseness and pneumomediastinum [3]. [austinpublishinggroup.com]

  Inspiratory stridor is the hallmark of airway obstruction at or above the level of the vocal cords. Blood, mucus, vomitus, teeth, or other foreign bodies may cause the stridor. [emedicine.com]

  Patients with cervical tracheal injuries may present with stridor and severe respiratory distress or with hoarseness, hemoptysis, or cervical subcutaneous emphysema. [clinicalgate.com]

  Table 1 Causes, presentation and diagnosis of tracheal and bronchial injury Full table Typical clinical features will include stridor, dyspnoea, haemoptysis, subcutaneous emphysema, tension pneumothorax and persistent or large air leak, which will mandate [jtd.amegroups.com]

  OBSTRUCTION OR DISRUPTION Recognition External neck deformity or hematoma, crepitus from laryngeal fracture, surgical emphysema, hoarse voice or gurgling Complete airway obstruction — silent chest, paradoxical chest movements Partial airway obstruction — stridor [lifeinthefastlane.com]

• Inspiratory Stridor

  Inspiratory stridor is the hallmark of airway obstruction at or above the level of the vocal cords. Blood, mucus, vomitus, teeth, or other foreign bodies may cause the stridor. [emedicine.com]

• Sputum

  Table 1 Results of surgery in patients with traumatic airway injuries Barmada (23) 7 R Thoracotomy: 5 L. pneumonectomy: 1 0% Wound infection: 2 L Thoracotomy: 2 ML. lobectomy: 1 Sputum retention: 1 Segmentectomy: 1 Primary suture: 4 Rossbach (19) 32 Collar [cardiothoracicsurgery.biomedcentral.com]

• Chest Pain

  The "Cardinal Presentations Section" provides quick and easy reference to differential diagnosis and directed testing for fever in the adult patient; dizziness and vertigo; chest pain; and over 20 other frequently seen presentations in the emergency department [books.google.com]

  MVC, fall, airplane crash), complaints of chest pain, dyspnea, hoarseness (frequently absent) - Decreased femoral pulses, differential arm BP (arch tear) - CXR, CT scan, transesophageal echo (TEE), aortography (gold standard) - see below for CXR features [fprmed.com]

  pain, dyspnea ) In case of rupture: signs of hemorrhagic shock ( tachycardia, hypotension ) Diagnostics Initial test: chest x-ray Mediastinal widening Tracheal deviation Hemothorax Further tests Treatment Prognosis : ∼ 80% of patients die before reaching [amboss.com]

  pain and hemoptysis and they may lack the serial rib fractures typical of adults after massive thoracic trauma because a child's chest is much more elastic than an adult's chest. [saudija.org]

  […] and back pain. [lifeinthefastlane.com]

• Hypotension

  cool peripheries Beck’s triad: muffled heart sounds, hypotension and distended neck veins — not especially in a noisy trauma bay! [lifeinthefastlane.com]

  This causes hypoxia, decreased venous return, and eventually, hypotension. [ahcmedia.com]

  […] left subclavian artery ( ∼ 70% ) Severity : ranges from intimal lesions to aortic rupture Clinical features Initially often asymptomatic or unspecific findings (e.g., chest pain, dyspnea ) In case of rupture: signs of hemorrhagic shock ( tachycardia, hypotension [amboss.com]

  Upon arrival in ED, the patient was noted to have blood spurting out of King Tube, was tachycardic and hypotensive, GCS 5, but with no other outward signs of trauma (no abrasions, lacerations, ecchymosis) – impressively unimpressive visual appearance. [emdocs.net]

  This process is potentiated by systemic hypotension and hypoxia. [worldwidewounds.com]

• Hypertension

  David Kaminsky to cover important topics like pulmonary hypertension, COPD, asthma, drug-resistant TB, modern endoscopic and surgical techniques, and more. [books.google.com]

  These children should be monitored in the intensive care unit for 24 hours because of the potential for airway obstruction secondary to venous hypertension and petechiae generated under the tongue and oropharynx. [emedicine.com]

  […] bronchial injuries and some lower tracheal Bronchial reconstruction: 10 Airway stenosis: 5 Pneumonectomy; 14 Empyema: 3 (BPF in 2) Suture granuloma: 6 Delayed presentation: primary repair (1), resection and anastomosis (1), pneumonectomy (1) Pulmonary hypertension [cardiothoracicsurgery.biomedcentral.com]

• Confusion

  There are many, confusing classification systems for pelvic fractures. [worldwidewounds.com]

  Skin folds, clothing, ECG leads, and IV lines may produce lines on the CXR that can be confused with pneumothorax. These lines will have vascular markings lateral to them and can be followed outside the pleural space. [ahcmedia.com]

• Atelectasis

  […] trauma Chest wall injury Etiology : mostly blunt trauma, pathologic fractures, nonaccidental trauma ( child abuse ) Clinical features Diagnostics Complications Pneumothorax Hemothorax Especially in the elderly: pain → splinting and hypoventilation → atelectasis [amboss.com]

  Associated morbidity includes tracheal stenosis, atelectasis, pneumonia, mediastinitis, sepsis, and decreased pulmonary function. [emdocs.net]

  In cases where an early diagnosis of bronchial tear is not made and repair not done, one of the two clinical courses may follow: 1) An incomplete laceration heals with stricture formation and results in recurrent atelectasis, infection and bronchiectasis [file.scirp.org]

  A surgical procedure was decided upon, and confirmed a complete disruption of the right bronchus immediately below the origin of the right upper bronchus with an atelectasis of the right middle and inferior lobes. [doi.org]

  Complete obstruction without infection leads to prolonged atelectasis and diminished pulmonary function. While concomitant injury is the rule rather than the exception, patterns of associated injuries vary widely. [clinicalgate.com]

The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI). [ncbi.nlm.nih.gov]

For the treatment modalities see Table 1. [doi.org]

We are also able to assess the mortality associated with the location and side of injury, examine the time from injury until diagnosis and treatment, and evaluate treatment outcome. [scienceopen.com]

[…] asymptomatic or unspecific findings (e.g., chest pain, dyspnea ) In case of rupture: signs of hemorrhagic shock ( tachycardia, hypotension ) Diagnostics Initial test: chest x-ray Mediastinal widening Tracheal deviation Hemothorax Further tests Treatment Prognosis [amboss.com]

Therefore, the prognosis is better. The prognosis of tracheobronchial ruptures is often related to the severity of associated injuries in these multiple injured patients. [file.scirp.org]

[…] common in children than in adults and there are two peaks of incidence: 5-6 years old children tend to be pedestrians involved in traffic accidents and falls at home and 12-14 years old children tend to be involved in motorbike accidents. [5], [6] The prognosis [saudija.org]

Multisystem involvement is reported in more than 50% of children with thoracic trauma and portends a worse prognosis. [emedicine.com]

[…] tissue) may be removed in order to get clean edges that can be surgically repaired. [10] When lung tissue is destroyed as a result of TBI complications, pneumonectomy or lobectomy (removal of a lung or of one lobe, respectively) may be required. [17] Prognosis [wikidoc.org]

References: [1] [2] [3] [4] Blunt chest trauma Chest wall injury Etiology : mostly blunt trauma, pathologic fractures, nonaccidental trauma ( child abuse ) Clinical features Diagnostics Complications Pneumothorax Hemothorax Especially in the elderly: [amboss.com]

The etiology comprises blunt trauma, explosion injuries, penetrating or gunshot wounds, and iatrogenic injuries. Ruptures of the tracheobronchial tree often present a dramatic, life-threatening situation. [doi.org]

View Article PubMed Google Scholar Wintermark M, Schnyder P: The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest. 2001, 120: 543-547. 10.1378/chest.120.2.543. [ccforum.com]

Christos Prokakis, Efstratios N Koletsis, Panagiotis Dedeilias, Fotini Fligou, Kriton Filos and Dimitrios Dougenis, Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment, Journal of Cardiothoracic Surgery, 9, 1, (2014) [doi.org]

References Prokakis C, Koletsis E, Dedeilias P, et al: Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014;9:117. Altinok T, Can A: Management of tracheobronchial injuries. [karger.com]

Results All injuries involved the intrathoracic trachea with 32 cases as both acute and delayed cases has different epidemiology, management plane and subsequently in there outcome which we categorized according to time or presentation into acute 25 [file.scirp.org]

Review Epidemiology The true incidence of TBI is still unknown as 30–80% of these trauma victims still die at the scene of the accident[ 3 ]. [cardiothoracicsurgery.biomedcentral.com]

[…] people who have tracheobronchial tears surgically repaired early in treatment. [9] Even when surgery is performed years after the injury, the outlook is good, with low rates of death and disability and good chances of preserving lung function. [17] Epidemiology [wikidoc.org]

Grasp the nuances of the pathophysiology of today’s major respiratory conditions—including pulmonary hypertension, COPD, asthma, environmental lung disease, sleep disorders, infections of the immunocompromised, neonatal breathing disorders, and drug-resistant [books.google.com]

The pathophysiology involves reduction in blood flow to a contused cardiac muscle, followed by ischemia. [emedicine.com]

View Article PubMed Google Scholar Chhabra A, Rudigwa P, Panneer Selvam SR: Pathophysiology and management of airway trauma. Trends Anaesth Crit Care. 2013, 3: 216-219. [cardiothoracicsurgery.biomedcentral.com]

Early diagnosis is important to prevent complications, which include stenosis (narrowing) of the airway, respiratory tract infection, and damage to the lung tissue. [en.wikipedia.org]

However, for there to be any significant reduction in the worldwide burden of motor vehicle-related trauma, injury prevention strategies are needed; prevention being better than cure. [worldwidewounds.com]

After operation prevention of further damage to the trachea depends on careful respiratory management. [thorax.bmj.com]

The described surgical approaches are transcervical, transthoracic or median sternotomy. [18 ] The potential benefits of surgery are: 1) closure of the defect to facilitate effective ventilation, 2) prevent mediastinitis due to contamination from non [tropicalgastro.com]

Nevertheless, both of these techniques require that cannulas be present in the operative field, which often prevents adequate visualization in smaller children. [emedicine.com]