Diagnostic and management dilemmas in a patient with tracheal trauma

A patient with a foreign body penetrating the neck and chest was found to have physical signs which were consistent with serious tracheal injury and included a large movement of air through the lower part of the neck. The subsequent management of the patient and the difficult problem of securing an airway are described. At operation, the tracheal damage was found to be less severe than anticipated and the observed air flow was a result of penetration of the foreign body into the pleural cavity. The management of the patient is discussed and the potential for misinterpretation of the physical signs in this type of trauma is emphasized.