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]

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

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

• Multiple Organ Dysfunction Syndrome

  Most late deaths that occur in TBI are attributed to sepsis or multiple organ dysfunction syndrome (MODS). [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. [ejcts.oxfordjournals.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]

  Coughing may be present, and stridor, an abnormal, high-pitched breath sound indicating obstruction of the upper airway can also occur.Damage to the airways can cause subcutaneous emphysema (air trapped in the subcutaneous tissue of the skin) in the abdomen [en.wikipedia.org]

• 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]

• 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 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]

  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]

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

• Suggestibility

  Abnormal hyoid bone elevation suggests a cervical tracheal tear. [emedicine.com]

  In one case, CT showed just direct "air leak" at the level of the carina suggesting main bronchus injury. This finding was confirmed by bronchoscopy. Chest radiograph was helpful for the assessment of iatrogenic tracheal injuries. [ncbi.nlm.nih.gov]

  You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. share alike – If you alter, transform, or build upon this work, you may distribute the resulting work only under the same or similar license [commons.wikimedia.org]

  A pneumothorax that persists despite adequate placement of a thoracostomy tube and has a continuous air leak is suggestive of tracheobronchial injury and bronchopleural fistula. [clinicalgate.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]

  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]

  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]

• Right Pleural Effusion

  This image shows loculated right pleural effusion, longitudinal sternal fracture, and right rib fractures. [emedicine.com]

• Pseudomonas

  A second ventilator-associated pneumonia caused by Pseudomonas aeruginosa delayed withdrawal of the patient from mechanical ventilation, which was successfully achieved on day 18. [doi.org]

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]

Although relatively rare, diagnosis and treatment of TBI often requires skillful and creative airway management, careful diagnostic evaluation, and operative repairs that are often resourceful and necessarily unique to the given injury. [uthscsa.influuent.utsystem.edu]

[…] 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]

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]

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]

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