Tzu Chi Medical Journal
Volume 21, Issue 1 , Pages 77-80, March 2009

Delayed Diagnosis of Complete Tracheal Transection After Blunt Neck Trauma

  • Shih-Hsuan Hsiao

      Affiliations

    • Department of Otolaryngology and Head and Neck Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Bing-Shuo Chen

      Affiliations

    • Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Tsan-Mu Lee

      Affiliations

    • Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Szu-Yi Hsu

      Affiliations

    • Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Yu-Yung Lai

      Affiliations

    • Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Anesthesiology, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan

Received 24 January 2008; received in revised form 11 February 2008; accepted 27 May 2008.

Article Outline

Abstract 

The clinical features of tracheal injury include hoarseness, subcutaneous emphysema and edema, and bruising of the neck. Patients with tracheal injury may present with minimal signs that are easily overlooked. The priority in treating such patients is to appropriately identify the tracheal anatomy before further treatment is administered. In this case, a male patient aged 17 years was injured over the first tracheal ring while riding a motorcycle. His stable condition obscured pathognomonic signs of complete cervical tracheal transection, which caused an unnecessary delay in treatment. In a case such as ours, the application of high resolution computed tomography (CT), as an adjuvant to bronchoscopy is important. If tracheal transection is suspected, the proximal and distal ends of the trachea might be not on the same axis and traditional laryngoscopy should not be performed in haste. A CT virtual bronchoscopic evaluation can provide great accuracy when analyzing the central and segmental bronchi, and can prevent a delayed diagnosis of complete tracheal transection. If the diagnosis is still not definite, then diagnostic bronchoscopy and intubation at the operating room is recommended.

Keywords:  Blunt injury , Bronchoscopy , Trachea , Tracheal transection

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PII: S1016-3190(09)60013-6

doi:10.1016/S1016-3190(09)60013-6

Tzu Chi Medical Journal
Volume 21, Issue 1 , Pages 77-80, March 2009

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