[Tracheal rupture in a patient with head and thoracic injuries]

A 49-year-old patient presented with cranioencephalic injuries including subdural hematoma and severe mass effect, facial and thoracic injuries with bilateral rib fractures but no parenchymatous lesions or extrapulmonary air. After surgical evacuation of the subdural hematoma, the patient entered the intensive care unit. Twenty-four hours later the patient pulled out the tubes, which were reinserted after signs of respiratory failure appeared. A series of clinical and radiological signs then followed, namely subcutaneous cervicothoracic emphysema, mediastinitis accompanied by hyperinsufflated balloon tamponade (pressures < 28 cmH2O). Tracheal rupture was suspected, but fibrebronchoscopy through the trachea revealed no damage. Surgical exploration 72 hours after admission confirmed high tracheal rupture near the pars membranacea. The damage was sutured, but sepsis with severe respiratory distress and mediastinitis led to death.