Usefulness of the 3-Dimensionally Reconstructed Computed Tomography Imaging for Diagnosis of the Site of Tracheal Injury (3D-Tracheography)

Critical Care and Emergency Center, Yokohama Ciyu University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
World Journal of Surgery (Impact Factor: 2.64). 02/2005; 29(1):102-5. DOI: 10.1007/s00268-004-7433-1
Source: PubMed


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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    • "Virtual bronshoscopy is a novel technique which comprises a computer generated volumetric reconstruction of the tracheobronchial tree based on MPR/3D images obtained during multi-slice CT imaging of the airway [33]. The technique simulates the findings at conventional bronshoscopy, and therefore it could represent a valid alternative for the evaluation of the airway, even for the detection of TBI in selected patients with more stable airway injuries [34,35]. "
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    ABSTRACT: Airway injuries are life threatening conditions. A very little number of patients suffering air injuries are transferred live at the hospital. The diagnosis requires a high index of suspicion based on the presence of non-specific for these injuries symptoms and signs and a thorough knowledge of the mechanisms of injury. Bronchoscopy and chest computed tomography with MPR and 3D reconstruction of the airway represent the procedures of choice for the definitive diagnosis. Endotracheal intubation under bronchoscopic guidance is the key point to gain airway control and appropriate ventilation. Primary repair with direct suture or resection and an end to end anastomosis is the treatment of choice for patients suffering from tracheobronchial injuries (TBI). The surgical approach to the injured airway depends on its location. Selected patients, mainly with iatrogenic injuries, can be treated conservatively as long as the injury is small (<2 cm), a secure and patent airway and adequate ventilation are achieved, and there are no signs of sepsis. Patients with delayed presentation airway injuries should be referred for surgical treatment. Intraoperative evaluation of the viability of the lung parenchyma beyond the site of stenosis/obstruction is mandatory to avoid unnecessary lung resection.
    Full-text · Article · Jun 2014 · Journal of Cardiothoracic Surgery
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    • "When a closed injury to the cervical trachea is suspected, it is important to perform immediate neck and chest X-rays, or CT scanning including three-dimensional imaging of the trachea [4]. can clearly show the fascial sheaths, artery sheaths, trachea, esophagus, and larynx, and is the most important preoperative diagnostic imaging modality for determining the location, extent, and type of tracheal injury [5-7]. In stable patients, bronchoscopy can be used to determine the precise location and degree of tracheal injury. "
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    ABSTRACT: We retrospectively reviewed the presentation, diagnosis, treatment, and outcomes of patients with closed injury of the cervical trachea. We evaluated factors that improve diagnosis and treatment, reduce mortality, and avoid tracheal stenosis. We reviewed the clinical data of 17 patients with closed injury of the cervical trachea. All patients underwent CT scanning or endoscopy, tracheal exploration, low tracheotomy, and tracheal repair. In 12 patients, breathing, phonation, and swallowing functions had returned to normal at 2 weeks. In three patients, breathing and swallowing functions had recovered at 2 weeks, but hoarseness continued. In two patients, tracheal stenosis prevented extubation and required further surgery; in these patients breathing and swallowing functions had recovered at 6 months. Closed injury of the cervical trachea may cause airway obstruction and is potentially life-threatening. Early diagnosis and repair to restore structure and function are important to ensure survival and avoid tracheal stenosis.
    Full-text · Article · Aug 2013 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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    • "Moriwaki studied 3-D reconstructed CT for diagnosing tracheal injury site. 3-D CT accurately identified the site of injury, as confirmed by bronchoscopy [17]. In conjunction with CT, panendoscopy ensures complete evaluation of aerodigestive injuries. "
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    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.
    Full-text · Article · Sep 2007 · Emergency Medicine Clinics of North America
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