Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented.
Humans ; Female ; Adult ; Pneumothorax/surgery* ; Bronchi/injuries* ; Wounds, Nonpenetrating/diagnosis* ; Bronchoscopy ; Trachea/injuries*

Injuries caused by free-fall from heights represent a specific form of blunt trauma that can be difficult to interpret, especially when the impact medium is water. On autopsy practice, the immersed bodies with rib fractures and internal organ injuries were often encountered and many studies have reported that impact with the water surface could cause skeletal fracture and visceral organ rupture. The height of the fall and body orientation on impact are the most important factors determining the severity and range of these injuries. In the present case, the victim was a 69-year-old male who weighed 48 kg. Following were the autopsy findings: numerous pin-point epidermal injuries on the body surface (like those due to nibbling by fish), a massive soft tissue hemorrhage in the left upper chest, multiple rib fractures (3rd–7th left ribs), ballooning of the lungs, froth in the trachea and bronchus, pericardial tearing in the right anterolateral side (7-cm long), intra-pericardial hemorrhage, and focal hemorrhage in the adventitia of the intra-pericardial aorta. No sign of an external wound was observed in the left chest area. The cause of death was drowning, and the manner of death was suicide. Unfortunately, the site and height of fall were not investigated.
Adventitia ; Aged ; Aorta ; Autopsy ; Bronchi ; Cause of Death ; Drowning ; Hemorrhage ; Humans ; Lung ; Male ; Rib Fractures ; Rupture ; Suicide ; Tears ; Thorax ; Trachea ; Water ; Wounds and Injuries

Traumatic bronchial injury (TBI) is rare and often fatal, usually a result of blunt or penetrating chest trauma. Clinical manifestations of TBI include pneumothorax, pneumomediastinum, subcutaneous emphysema and continuous air leakage despite thoracostomy with negative pressure. However, TBI is initially difficult to diagnose because its signs are similar to other chest traumas. Delayed diagnosis of TBI can result in sepsis, bronchial stenosis, hypoxic injury, and eventually can cause death. We experienced two patients with TBI, possibly a result of blunt chest trauma. We did not diagnose TBI in the emergency room because we did not suspect it. During surgery, we discovered right bronchial rupture, so performed end to end anastomosis of bronchus in two patients. This report discusses the rare occurrence of TBIs due to chest trauma; our aim is to increase awareness of this diagnosis in the trauma center.
Bronchi ; Constriction, Pathologic ; Delayed Diagnosis ; Diagnosis ; Emergency Service, Hospital ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Rupture ; Sepsis ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracostomy ; Thorax* ; Trauma Centers

Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may cause airway obstruction and resulting life-threatening respiratory deficiency. However, the clinical presentations are variable and frequently difficult to diagnose. We report a case of a previously healthy 16-year-old man with complete right main bronchial transection sustained after a vehicular accident, who had progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax. Prompt chest tube drainage for suspected bilateral tension pneumothorax and a tracheal intubation were performed. Shortly after the positive pressure ventilation, severe subcutaneous emphysema developed and he was at risk for developing shock. Additional chest tubes were inserted. An emergency bronchoscopy showed rupture of the right main bronchus. After changing to a double lumen endotracheal tube, the patient’s condition improved. A surgical closure was performed and postoperative bronchoscopy showed good repair. The patient was discharged without complications.
Adolescent ; Airway Obstruction ; Bronchi ; Bronchoscopy ; Chest Tubes ; Drainage ; Dyspnea ; Emergencies ; Humans ; Intubation ; Neck ; Pneumothorax ; Positive-Pressure Respiration ; Rupture* ; Shock ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracic Wall ; Thorax*

OBJECTIVETracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.

METHODSA retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.

RESULTSThe average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.

CONCLUSIONSTracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.

Adult ; Bronchi ; injuries ; Developing Countries ; Female ; Humans ; Male ; Retrospective Studies ; Trachea ; injuries

Adolescent ; Airway Obstruction ; Bronchi ; pathology ; Bronchography ; Child ; Diagnosis, Differential ; Foreign Bodies ; Humans ; Inhalation ; Male ; Obesity, Morbid ; complications ; Prader-Willi Syndrome ; complications ; Radiography, Thoracic ; Sleep Apnea, Obstructive ; complications ; diagnosis ; Thoracic Injuries ; diagnosis ; Tomography, X-Ray Computed ; Trachea ; pathology

OBJECTIVETo study the X-ray and CT findings of traumatic bronchial rupture for early radiographic diagnosis and treatment.

METHODSThe chest plain X-ray films and CT images of 21 patients with traumatic bronchial rupture confirmed by operations or bronchoscopy were retrospectively analyzed.

RESULTSThe main radiographic findings of traumatic bronchial rupture included interrupted tracheobronchial air column, atelectasis, lung ptosis, pneumomediastinum and subcutaneous emphysema, pneumothorax or hydropneumothorax. CT scanning also revealed tracheobronchial wall defect, bronchostenosis, and bronchial occlusion, displacement and angulation.

CONCLUSIONChest plain X-ray film combined with CT scanning has important values for early diagnosis of traumatic bronchial rupture.

Adolescent ; Adult ; Aged ; Bronchi ; injuries ; surgery ; Bronchoscopy ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Young Adult

Adult ; Bronchi ; pathology ; Foreign Bodies ; etiology ; Humans ; Male ; Neck Injuries ; etiology ; Trachea ; injuries

To investigate the roles of glycogen synthase kinase 3beta (GSK3beta) and adenomatous polyposis coli (APC) protein in wound repair of airway epithelial cells (AECs), we established a wound model of airway epithelium in vitro. Then the following tests were undertaken: (1) Western blot was used to detect the levels of total GSK3beta and phosphorylated GSK3beta in human bronchial epithelial (16HBE) cells; (2) The localizations of APC protein was observed by using immunofluorescence technique; (3) Immunoprecipitation was used to investigate the relationship between APC protein and GSK3beta during the repair of 16HBE cells. The results were as follows: (1) The level of phosphorylated GSK3beta increased 0.5 h after scratching (P<0.05), reached a maximum at 6 h (P<0.05), and maintained until 12 h, while the total level of GSK3beta remained constant; (2) Results of immunofluorescence study showed that APC protein clustered with tubulin in the region of the migrating leading cells 6 h after scratching, which was dissimilar with that in the cells 0 h after scratching; (3) GSK3beta and APC protein were immunoprecipitated and analysed on SDS-PAGE. We found that GSK3beta and APC protein were precipitated, indicating that the two proteins existed in a complex. After scratching, dissociation of the two proteins occurred. Taken together, we conclude that scratching caused a decrease in phosphorylation of GSK3beta, and that reduced phosphorylation of GSK3beta promoted APC protein to bind to the plus ends of microtubules and stabilize the growing ends. These observations suggest that APC protein and GSK3beta may synergistically play an important role in the repair of airway epithelium.
Adenomatous Polyposis Coli Protein ; physiology ; Bronchi ; cytology ; injuries ; Cell Line ; Epithelial Cells ; metabolism ; pathology ; Glycogen Synthase Kinase 3 ; physiology ; Glycogen Synthase Kinase 3 beta ; Humans ; Phosphorylation ; Wound Healing ; physiology

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.
Wounds, Nonpenetrating/*diagnosis ; Tomography, X-Ray Computed/*methods ; Time Factors ; Thoracic Injuries/*diagnosis ; Male ; Humans ; Constriction, Pathologic ; Child, Preschool ; Child ; Bronchial Neoplasms/*pathology ; Bronchi/*injuries/pathology ; Accidents, Traffic