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.
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ABSTRACT: Acute posttraumatic tracheobronchial lesions are rare events associated with significant morbidity and mortality. They are caused by blunt and penetrating trauma, or they are iatrogenic, appearing after intubation or tracheotomy. Although surgery has traditionally been considered the treatment of choice for these injuries, recent reports show that conservative treatment can be effective in selected patients. The aim of this study was to evaluate the role of surgical and conservative management of these lesions, differentiated on the basis of clinical and endoscopic criteria. From January 1993 to October 2010, a total of 50 patients with acute posttraumatic tracheobronchial lesions were referred for treatment to our department. In all, 36 patients had iatrogenic injuries of the airway, and 14 had lesions resulting from blunt or penetrating trauma. Of the 30 patients who underwent surgery, the lesion was repaired with interrupted absorbable sutures in 29; the remaining patient, with an associated tracheoesophageal fistula, underwent single-stage tracheal resection and reconstruction and closure of the fistula. In all, 20 patients were treated conservatively: clinical observation in 5 patients, airway decompression with a mini-tracheotomy cannula in 4 spontaneously breathing patients, and tracheotomy with the cuff positioned distal to the lesion in 11 mechanically ventilated patients. One surgical and one conservatively-managed patient died after treatment (4% overall mortality). Complete recovery and healing were achieved in all the remaining patients. Surgery remains the treatment of choice for posttraumatic lesions of the airway. However, conservative treatment based on strict clinical and endoscopic criteria-stable vital signs; effective ventilation; no esophageal injuries, signs of sepsis, or evidence of major communication with the mediastinal space-enables favorable results to be achieved in selected patients.World Journal of Surgery 09/2011; 35(11):2568-74. · 2.35 Impact Factor
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ABSTRACT: We report a case of an iatrogenic tracheal rupture following an endotracheal intubation. The 78-year-old patient was admitted to the intensive care unit because of an acute respiratory failure related to a severe nosocomial pneumonia occurring 21 days after an abdominal aorta surgery. His main antecedent was a cigarette smoke-induced chronic obstructive pulmonary disease. Immediately after being intubated, a traumatic tracheobronchial rupture was suspected because of the sudden appearance of cervicothoracic subcutaneous emphysema. A thoracic computed tomography with multiplanar reformations confirmed the diagnosis and the evolution was unfortunately rapidly unfavourable. Risk factors, clinical and radiological aspects, and management of this rare but serious complication of endotracheal intubation will be discussed.Annales Françaises d Anesthésie et de Réanimation 06/2007; 26(6):600-603. · 0.84 Impact Factor
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ABSTRACT: Pneumomediastinum occurs in up to 10% of patients with blunt thoracic and cervical trauma. Mandatory evaluation of all patients with bronchoscopy and esophageal imaging to exclude a major injury has been recommended. There is little data on the safety or efficacy of this approach. We evaluated the incidence of major injuries associated with pneumomediastinum, the accuracy of diagnostic modalities, and the results of observation versus aggressive evaluation. Medical records of all blunt trauma patients diagnosed with pneumomediastinum and/or aerodigestive tract injury between 1998 and 2005 were reviewed. The patient's hospital course was reviewed for demographic data, admission diagnoses, diagnostic imaging and procedures, operations, missed injuries, length of stay, and mortality. The review identified a total of 136 patients with pneumomediastinum, and an additional 22 patients with thoracic aerodigestive tract injuries but without pneumomediastinum. Only patients with pneumomediastinum were considered in subsequent analysis. Pneumomediastinum was detected by CT scan in all 136 (100%) patients, although identified on plain radiograph in only 20 (15%) patients. Computed tomography findings were suspicious for a major aerodigestive tract injury in 27 (20%) patients. Ten (37%) of these 27 patients had an injury requiring operative intervention: five (4%) laryngeal injuries, three (2%) tracheal disruptions, and two (1%) esophageal perforations. Eighty-one patients (60%) never had endoscopic evaluation. There were no delayed diagnoses, missed injuries, or complications in the observation-only cohort. The overall sensitivity and specificity of CT scan for major aerodigestive tract injury was 100% and 85%, respectively. Major airway or esophageal injury is an uncommon cause of pneumomediastinum. CT scan was able to identify patients at high risk for aerodigestive injury in all cases, and should be the preferred screening tool for airway injury in patients with pneumomediastinum.The Journal of trauma 01/2009; 65(6):1340-5. · 2.35 Impact Factor