Abstract
Seven cases of injury to the tracheobronchial tree in closed trauma of the thorax, treated by the surgical emergency service of the Hospital das Clínicas, University of São Paulo School of Medicine, during the period 1980-2 are described and compared with previously published cases. The diagnosis of the seven cases presented in this series was clinically suspected and endoscopically confirmed within 24 hours of injury, all patients being immediately submitted to reconstructive surgery; and except for one who failed to respond to initial resuscitation and died during surgery all the patients had a satisfactory postoperative course. Many previously reported cases of tracheobronchial injury by contrast have taken more than a month to be diagnosed; but for the best results such injuries must be repaired immediately. Awareness of the possibility of tracheobronchial injury in cases of violent chest trauma is important for early diagnosis; emphysema, dyspnoea, and pneumothorax are not always present, and absence of radiological and clinical signs of tracheobronchial injury does not exclude such injury. Bronchoscopy is the most important investigation for clinical diagnosis. Once the diagnosis has been made thoracotomy is nearly always required. Throughout the surgical procedure expert cooperation between anaesthetist and surgeon is essential. After operation prevention of further damage to the trachea depends on careful respiratory management.
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Selected References
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- Chesterman J. T., Satsangi P. N. Rupture of the trachea and bronchi by closed injury. Thorax. 1966 Jan;21(1):21–27. doi: 10.1136/thx.21.1.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gomez-Engler H. E., Barker A. F., Klein R., Dietl C. A., Macmanus Q., Torstveit J., Knight R., Lawrence H., Starr A. Post-traumatic bronchial stenosis and acute respiratory insufficiency. J Thorac Cardiovasc Surg. 1980 Jun;79(6):864–867. [PubMed] [Google Scholar]
- Guest J. L., Jr, Anderson J. N. Major airway injury in closed chest trauma. Chest. 1977 Jul;72(1):63–66. doi: 10.1378/chest.72.1.63. [DOI] [PubMed] [Google Scholar]
- HOOD R. M., SLOAN H. E. Injuries of the trachea and major bronchi. J Thorac Cardiovasc Surg. 1959 Oct;38:458–480. [PubMed] [Google Scholar]
- Harvey-Smith W., Bush W., Northrop C. Traumatic bronchial rupture. AJR Am J Roentgenol. 1980 Jun;134(6):1189–1193. doi: 10.2214/ajr.134.6.1189. [DOI] [PubMed] [Google Scholar]
- Kirsh M. M., Orringer M. B., Behrendt D. M., Sloan H. Management of tracheobronchial disruption secondary to nonpenetrating trauma. Ann Thorac Surg. 1976 Jul;22(1):93–101. doi: 10.1016/s0003-4975(10)63961-6. [DOI] [PubMed] [Google Scholar]
- Lawhorne T. W., Jeyasingham K., Kieffer R. F. Transection of the trachea secondary to blunt trauma. Br J Surg. 1978 Mar;65(3):176–178. doi: 10.1002/bjs.1800650310. [DOI] [PubMed] [Google Scholar]
- Lotz P. R., Martel W., Rohwedder J. J., Green R. A. Significance of pneumomediastinum in blunt trauma to the thorax. AJR Am J Roentgenol. 1979 May;132(5):817–819. doi: 10.2214/ajr.132.5.817. [DOI] [PubMed] [Google Scholar]
- McGrath J. P. Burst trachea. Br J Surg. 1968 Jan;55(1):77–78. doi: 10.1002/bjs.1800550121. [DOI] [PubMed] [Google Scholar]
- Urschel H. C., Jr, Razzuk M. A. Management of acute traumatic injuries of tracheobronchial tree. Surg Gynecol Obstet. 1973 Jan;136(1):113–117. [PubMed] [Google Scholar]
- Wood M. H., Gerrick S. J., Lucas C. E. Primary repair for closed lobar bronchus injury. J Trauma. 1978 Sep;18(9):682–683. doi: 10.1097/00005373-197809000-00014. [DOI] [PubMed] [Google Scholar]