Usefulness of the 3-dimensionally reconstructed computed tomography imaging for diagnosis of the site of tracheal injury (3D-Tracheography)
ABSTRACT Computed tomography (CT) has not been considered useful for early diagnosis of traumatized patients who could hardly hold their breath, particularly patients with tracheal injuries. However, the recent development of spiral CT has made it possible to acquire contiguous patient data, which eliminates the respiratory misregistration. Air is easily differentiated from surrounding tissues by striking contrast, and the trachea can therefore be well displayed by three-dimensional (3D)-CT. We consider that it is possible to show tracheal injury by 3D-CT. The aim of this study is to clarify the usefulness of 3D-CT for detecting the injury site of blunt tracheal injuries. The study was carried out in hemodynamically stable patients who were suspected of having tracheal injury based on clinical manifestations such as hemoptysis, or cervical subcutaneous, deep cervical, or mediastinal emphysema. Repeated bronchoscopy confirmed tracheal injury. The virtual images of the 3D-CT (3D-tracheography) were compared with the direct images of bronchoscopic findings. Five cases were examined. In patients with tracheal injury, bronchoscopy revealed laceration of the tracheal lumen or disruption and dislocation of the tracheal cartilage, partially coated by mucus and clot, findings that confirmed the diagnosis of tracheal injury. The virtual images of the 3D-tracheography clearly showed the injury as a defect in the tracheal wall or a depression in the wall. The site and size of injury shown in the 3D-tracheography were comparable with those detected by bronchoscopy. We succeeded in detecting tracheal injuries by 3D-CT imaging, the virtual images of which were comparable with the bronchoscopic findings. 3D-tracheography is a useful method for diagnosing the site and form of tracheal injury in hemodynamically stable patients.
- SourceAvailable from: Ron Medzon
[Show abstract] [Hide abstract]
- "Moriwaki studied 3-D reconstructed CT for diagnosing tracheal injury site. 3-D CT accurately identified the site of injury, as confirmed by bronchoscopy . In conjunction with CT, panendoscopy ensures complete evaluation of aerodigestive injuries. "
ABSTRACT: Blunt and penetrating trauma to the neck can result in life-threatening injuries that demand immediate attention and intervention on the part of the emergency physician and trauma surgeon. This article provides a literature-based update of the evaluation and management of injuries to aerodigestive and vascular organs of the neck. A brief review of cervical spine injuries related to penetrating neck trauma is also included. Airway injuries challenge even the most skilled practitioners; familiarity with multiple approaches to securing a definitive airway is required because success is not guaranteed with any single technique.Emergency Medicine Clinics of North America 09/2007; 25(3):679-94, viii. DOI:10.1016/j.emc.2007.06.006 · 0.85 Impact Factor
[Show abstract] [Hide abstract]
- "Furthermore, emergent tracheostomy was considered risky because the distal trachea was located deeply in the mediastinum on CT. Although bronchoscopy is the essential method for diagnosing the site and form of tracheal injury, recently virtual bronchoscopy by 3-dimen- sional CT is reported as a useful method in haemodynamically stable patients . But in this case, it was becoming difficult to effectively ventilate this patient, and we decided to apply PCPS as soon as possible rather than perform 3D-CT. "
ABSTRACT: Blunt tracheobronchial injuries are rare, but can be life-threatening. A precise preoperative diagnosis and a well-recognised plan of surgical treatment, which may be unique for each patient, are needed to restore the continuity of tracheobronchial tree in a one-stage intervention. We encountered a patient with complete tracheal transection and 15 cm tear in the posterior membranous trachea and right bronchus, and whose tracheal injury was difficult to repair using direct intubation of distal airway by bronchoscopy. We achieved a good result of one-stage repair using a percutaneous cardiopulmonary support (PCPS).European Journal of Cardio-Thoracic Surgery 01/2007; 30(6):945-7. DOI:10.1016/j.ejcts.2006.09.009 · 2.81 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Bronchoscopy has been the gold standard for diagnosing blunt laryngo-cervical-tracheal injury (BLCTI); however, BLCTI is often undetected. Ultrasonography (US) is an indispensable tool in the field of critical care and traumatology, but has not been considered useful for evaluation of the airway. The aim of this study was to determine the usefulness of US in the diagnosis of BLCTI. To determine the detectability of BLCTI by US, we use a model of cylindrical plastic with a protruding mass made of paste. The model was placed in a water bath and US (3.5-MHz probe) was used to try to detect the mass. We could detect the existence of the mass as a high echoic mass with strongly high echoic tail. We used four patients with BLCTIs whose sites of injury were confirmed by computed tomography (CT) and bronchoscopy. We evaluated the larynx and the cervical trachea as their outline of air in the cranial section near the sternal notch using a 3.5-MHz convex probe. The following US findings were compared with CT and bronchoscopic images as specific findings of BLCTI: discontinuity of the laryngo-cervical-tracheal wall and an abnormal mass protruding into the laryngo-cervical-tracheal lumen. Specific findings of BLCTI were detected in three of the four patients, whose sites of injury were the anterior or lateral side of the larynx or the cervical trachea. The site of injury of the remaining patient, where we detected no specific BLCTI findings, was the posterior wall of the larynx. US is useful for the diagnosis of BLCTI because it is capable of presenting specific images showing BLCTI features such as discontinuity of the laryngo-cervical-tracheal wall and abnormal masses protruding into the lumen; not only as a single diagnostic tool but one tool with many uses.The Journal of trauma 12/2006; 61(5):1156-61. DOI:10.1097/01.ta.0000196761.35256.05 · 2.96 Impact Factor