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Rupture of the thoracic trachea following blunt trauma: diagnosis by CAT scan
S B Palder1, B Shandling, D Manson
1Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
A rare case of isolated thoracic trachea rupture in a child due to blunt trauma was successfully treated. Computed tomography (CT) scans aided diagnosis, leading to surgical repair and a good recovery.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Thoracic Surgery
Background:
- Isolated rupture of the thoracic trachea is a rare injury in children following blunt trauma.
- Massive subcutaneous emphysema and bilateral pneumothoraces can be initial presenting signs.
Observation:
- A 4-year-old child presented with symptoms suggestive of tracheal injury after blunt trauma.
- Computed tomography (CT) scan was instrumental in diagnosing the tracheal injury.
- Bronchoscopy confirmed a 3-cm rent in the membranous portion of the trachea.
Findings:
- Surgical repair via thoracotomy and primary closure of the tracheal rent was performed.
- Intraoperative ventilation challenges due to air leak were managed with intermittent tamponade.
- The child recovered well and was discharged on the sixth postoperative day.
Implications:
- CT scans are valuable for diagnosing tracheal injuries in pediatric blunt trauma.
- Early surgical intervention and primary closure are effective treatments for tracheal rupture.
- This case highlights the importance of considering tracheal injury in pediatric patients with severe blunt chest trauma.
Abstract:
A case of isolated rupture of the thoracic trachea due to blunt trauma in a 4-year-old child is presented. The rarity of this injury and its initial presentation as massive subcutaneous emphysema and bilateral pneumothoraces warrant its description. This child was diagnosed as having a tracheal injury by computed tomography scan. The diagnosis was confirmed at bronchoscopy and was successfully treated by thoracotomy and primary closure of a 3-cm rent in the membranous portion of the trachea. There was difficulty with intraoperative ventilation due to the large air leak through the tracheal tear. This was controlled by intermittent tamponade of the defect with sequential closure. Postoperatively, the child did well and was discharged on the sixth postoperative day. Rigid bronchoscopy done 2 months later showed no abnormality. This case demonstrates that computed tomography is helpful in the diagnosis of tracheal injuries. The treatment may require early operative intervention and closure of the defect.