Tracheobronchial Injuries

• • Blunt tracheobronchial injuries often the result of compression of the airway between the sternum and the vertebral column

  • Blunt injury usually involves distal trachea or mainstem bronchi

  • Penetrating tracheobronchial injuries may occur at any location

  • Tracheobronchial injury suspected with massive air leak or with poor reexpansion after chest tube placement

Epidemiology

• • Trauma patients

Symptoms and Signs

• • Most patients have pneumothorax, subcutaneous emphysema, and hemoptysis

  • Penetrating injuries usually cause massive hemoptysis

Imaging Findings

• • Pneumothorax

  • Pneumomediastinum

  • Subcutaneous air

  • Pneumothorax that persists after chest tube placement

• • Associated abdominal injuries may dictate care

• • Physical exam

  • ABG measurements

  • Chest x-ray

  • Late presenting injuries may require bronchoscopy

• • Resuscitation and stabilization

  • Chest tube

  • Intubation and mechanical ventilation

Surgery

• • Immediate primary repair is indicated for tracheobronchial laceration

Indications

• • Tracheobronchial laceration

Treatment Monitoring

• • Serial chest x-ray

  • Serial ABG measurements

References