대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Courtesy

St. Mary's Hospital, The Catholic University of Korea

Discussion

Tracheal or Bronchial Rupture
- Resulting from penetrating injury or intubation,blunt trauma, high-speed traffic accidents
- 30% of overall mortality in blunt trauma
- Findings of airway rupture are sometimes subtle and may be overshadowed by the other injury.


Radiographic Findings
- Pneumothorax (60-100%)
- Pneumomediastinum
- Coexistence of a pneumothorax and a pneumomediastinum; strongest indication of a bronchial rupture.
- If outer adventitial sleeve of the bronchus remains intact, no air leak (10%)

Pneumothorax
- Frequently large and under tension; air leak may be persistent after insertion of pleural tubes.
- Lung fails to re-expand
- “Fallen lung” sign

Pneumomediastinum
- More specific sign of a breach of airway integrity.
- Streaky lucencies in the carinal region extending superiorly as the air dissects in the tissue planes around the trachea, aorta, and great vessels.
- Lateral film

Disturbance of the ventilation of the affected lung
- Atelectasis may develop for reasons other than bronchial rupture or significant associated pulmonary abnromalities such as lung contusion or aspiration change
- Persistent and unresponsive to normal therapeutic endeavors

The diagnosis of bronchial rupture depends on awareness of this possibility of severe thoracic trauma.

Keywords

Airway, Trauma,