Bronchial injury

Background

Trachobronchial anatomy.

CT reconstruction of the trachea and bronchi showing disruption of the right main bronchus with abnormal lucency (arrow).

• Primarily due to rapid deceleration
• Most occur within 2cm of carina

Clinical Features

• Dyspnea, hemoptysis, subcutaneous emphysema, sternal tenderness
• Pneumothorax, pneumomediastinum

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Evaluation

Coronal CT chest view demonstrating left pneumothorax, extensive soft tissue emphysema, and left main bronchus disruption.

Axial CT chest view of a patient with a left main bronchus injury (not shown) demonstrating left pneumothorax, and soft tissue emphysema.

Management

• All lacerations of the bronchi involving more than 1/3 of the circumference need surg

See Also

• Thoracic trauma