Clinico-radiological correlates in rupture of the major airways

The plain film appearances of 17 patients with trauma to the major airways were reviewed and correlated with the findings at thoracotomy, bronchoscopy or post-mortem. Predictable radiographic patterns of air leak were discovered which related to the surgical anatomy of the rupture. Airway interruption was seen in two of three patients with laryngeal transection, all showing gross deep and superficial cervico-facial emphysema. Massive mediastinal and deep cervical emphysema without pneumothorax were striking features of tracheal injury. In patients with bronchial rupture all had ipsilateral pneumothorax and most had associated pneumomediastinum, the degree of each component relating to the site of rupture. Only two patients had tension pneumothoraces. These features alone, however, are non-specific and only two of seven patients with bronchial injury showed specific signs of rupture (a fallen lung). An understanding of the mechanisms of injury to the major airways and the predictable resultant patterns of air leak should ensure that such lesions are not overlooked in patients who will usually have sustained multisystem trauma.