Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma

Blunt thoracic trauma that results in tracheobronchial injury is difficult to diagnose. Many injuries are catastrophic and result in early mortality. Others are not immediately life threatening and are missed at initial presentation. Some of those injuries will later become symptomatic and will require medical attention. Ideal treatment in that situation is not yet clearly defined.

The objective is to review the current literature of delayed diagnoses of traumatic tracheobronchial injuries, their management, and the results of the most common repair methods. An interesting case report from this institution is presented as well.

A Medline search of the English literature of delayed presentation of tracheobronchial injuries over the past 10 years was performed. Delayed diagnosis was defined as injuries not identified during the initial hospitalization.

The median time from initial presentation to diagnosis was 6 months. Dyspnea (56%) and pneumonia (39%) were the most common complaints. No difference in complications was observed between parenchymal sparing procedures and resections.

Despite delays in presentation and the radiographic appearance of destroyed distal lung, proximal injuries can often be repaired without sacrifice of distal lung parenchyma. Bronchial sleeve resections or end-to-end anastomosis can be performed safely in most situations.