Tracheal Rupture After Trauma: A Successful Conservative Management

Abstract

Tracheobronchial injury (TBI) is a rare life-threatening injury that can result from either penetrating or blunt trauma. Treatment may be surgical or conservative, but the evidence regarding which is the best approach is still very scarce. This case report describes the successful conservative management of a 32-year-old male with a traumatic tracheal laceration. The alarming signs and symptoms, the imaging modalities of choice, the rationale behind the treatment strategy, and the most common complications are detailed here. Through this case, the authors wish to highlight the features that should lead to the suspicion of this potentially fatal traumatic injury, as well as raise awareness on how to adequately manage these patients.

Keywords: airway trauma; conservative treatment; surgical treatment; trachea; tracheal injuries.

Figure 1. Admission thoracic CT: Left anterolateral tracheal laceration in the thoracic portion (blue arrow); subcutaneous emphysema (white arrow)

Figure 2. Admission thoracic CT: Tracheal laceration (axial view)

Figure 3. Admission thoracic CT: Pneumomediastinum

Figure 4. First ICU day thoracic CT: Bilateral pneumothorax, more pronounced in the right lung field (blue arrow), aggravated subcutaneous emphysema (white arrow), and pneumomediastinum (yellow arrow)

Figure 5. First ICU day thoracic CT: Marked reduction of the tracheal lumen, less than 3 mm (blue arrow), more expressive subcutaneous emphysema (yellow arrow)

Figure 6. Discharge thoracic CT: Remaining bulging of the left lateral tracheal wall

Figure 7. Discharge thoracic CT: Remaining bulging of the left lateral tracheal wall (blue arrow), subcutaneous emphysema and pneumomediastinum reduction (yellow arrow)