Tracheobronchial laceration is a relatively rare type of trauma, mostly caused by severe trauma.
Clinical presentation and pathology
Clinical manifestations are related to the site and severity of the laceration, mainly thoracodynia, dyspnea, cyanosis, cough, hemoptysis, and subcutaneous emphysema. Tracheobronchial laceration can occur in various parts of the trachea and bronchus, predominantly near the carina, mostly 1 - 2 cm below the carina, and is more on the left than on the right. If the laceration is connected to the pleural cavity, pneumothorax may occur. If the laceration is in the mediastinum and the parietal pleura is intact, cervicothoracic and mediastinal extensive subcutaneous emphysema can occur.
Imaging manifestations
X-ray
Pneumothorax, mediastinal emphysema, and subcutaneous emphysema are common and important indirect signs. Chest x-ray in patients with mild tracheobronchial laceration may not show apparent abnormalities. In patients with severe laceration, the main bronchus is broken, resulting in severe pneumothorax; the collapsed lung tissue descends to the bottom of the thoracic cavity due to gravity; chest x-ray shows massive hyperdense opacity, and the upper edge is below the main bronchus.
CT
CT can clearly show secondary changes such as pneumothorax and mediastinal emphysema, but is difficult to show mild to moderate tracheobronchial laceration. Three-dimensional reconstruction of the bronchial tree in multi-slice spiral CT can show direct signs such as discontinuity of tracheobronchial wall and narrowed lumen.
Diagnosis and differential diagnosis
Severe tracheobronchial laceration has typical x-ray and CT manifestations, and diagnosis is not difficult. Mild to moderate tracheobronchial laceration often presents indirect signs such as pneumothorax and mediastinal emphysema; the post-processing function of multi-slice spiral CT should be used to reconstruct the bronchial tree and clarify the site and severity of tracheobronchial laceration to prevent missed diagnosis.