514:, occurring between the rings of the trachea, longitudinal or spiral. They may occur along the membranous part of the trachea, the main bronchi, or both. In 8% of ruptures, lesions are complex, occurring in more than one location, with more than one type of lesion, or on both of the main bronchi and the trachea. Transverse tears are more common than longitudinal or complex ones. The laceration may completely transect the airway or it may go only partway around. Partial tears that do not go all the way around the circumference of the airway do not allow a lacerated airway to become completely detached; tears that encircle the whole airway can allow separation to occur. Lacerations may also be classified as complete or incomplete. In an incomplete lesion, a layer of tissue surrounding the bronchus remains intact and can keep the air in the airway, preventing it from leaking into the areas surrounding the airways. Incomplete lacerations may require closer scrutiny to detect and may not be diagnosed right away.
187:
656:(removal of a lung or of one lobe, respectively) may be required. Pneumonectomy is avoided whenever possible due to the high rate of death associated with the procedure. Surgery to repair a tear in the tracheobronchial tree can be successful even when it is performed months after the trauma, as can occur if the diagnosis of TBI is delayed. When airway stenosis results after delayed diagnosis, surgery is similar to that performed after early diagnosis: the stenotic section is removed and the cut airway is repaired.
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compromise the circulation by preventing blood from returning to the heart from the head and lower body; this causes a potentially deadly reduction in the amount of blood the heart is able to pump out. Blood and other fluids can build up in the airways, and the injury can interfere with the patency of the airway and interfere with its continuity. However, even if the trachea is completely transected, the tissues surrounding it may hold it together enough for adequate air exchange to occur, at least at first.
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hospital alive, reports have found incidences of 2.1% and 5.3%. Another study of blunt chest trauma revealed an incidence of only 0.3%, but a mortality rate of 67% (possibly due in part to associated injuries). The incidence of iatrogenic TBI (that caused by medical procedures) is rising, and the risk may be higher for women and the elderly. TBI results about once every 20,000 times someone is intubated through the mouth, but when intubation is performed emergently, the incidence may be as high as 15%.
643:(inflammation of the tissues in the mid-chest) occurs; or if subcutaneous or mediastinal emphysema progresses rapidly; or if air leak or large pneumothorax is persistent despite chest tube placement. Other indications for surgery are a tear more than one third the circumference of the airway, tears with loss of tissue, and a need for positive pressure ventilation. Damaged tissue around a rupture (e.g. torn or scarred tissue) may be removed in order to obtain clean edges that can be surgically repaired.
379:
728:
are so small that they do not cause significant symptoms and are therefore never noticed. In addition, the injury sometimes is not associated with symptoms until complications develop later, further hindering estimation of the true incidence. However, autopsy studies have revealed TBI in 2.5–3.2% of people who died after trauma. Of all neck and chest traumas, including people that died immediately, TBI is estimated to occur in 0.5–2%. An estimated 0.5% of
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620:(PEEP) and ventilation at higher-than-normal pressures may be helpful in maintaining adequate oxygenation. However, such measures can also increase leakage of air through a tear, and can stress the sutures in a tear that has been surgically repaired; therefore the lowest possible airway pressures that still maintain oxygenation are typically used. The use of high frequency ventilation has been reported. Mechanical ventilation can also cause
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difficult in people with TBI. Intubation, one method to secure the airway, may be used to bypass a disruption in the airway in order to send air to the lungs. If necessary, a tube can be placed into the uninjured bronchus, and a single lung can be ventilated. If there is a penetrating injury to the neck through which air is escaping, the trachea may be intubated through the wound. Multiple unsuccessful attempts at conventional (direct)
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normally. However, infection is common in lungs distal to a partially obstructed bronchiole. Infected lung tissue distal to a stricture can be damaged, and wheezing and coughing may develop due to the narrowing. In addition to pneumonia, the stenosis may cause bronchiectasis, in which bronchi are dilated, to develop. Even after an airway with a stricture is restored to normal, the resulting loss of lung function may be permanent.
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589:, or cricothyroidotomy) in order to ensure an open airway. However, cricothyrotomy may not be useful if the trachea is lacerated below the site of the artificial airway. Tracheotomy is used sparingly because it can cause complications such as infections and narrowing of the trachea and larynx. When it is impossible to establish a sufficient airway, or when complicated surgery must be performed,
334:, and pulling apart. The first type of injury, sometimes called an "explosive rupture", may occur when the chest is violently compressed, for example when a driver strikes the steering wheel in a vehicle accident or when the chest is crushed. The pressure in the airways, especially the larger airways (the trachea and bronchi), quickly rises as a result of the compression, because the
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was probably first attempted in 1945, when the first documented case of a successful suturing of a lacerated bronchus was made. Prior to 1950, the mortality rate was 36%; it had fallen to 9% by 2001; this improvement was likely due to improvements in treatments and surgical techniques, including those for injuries commonly associated with TBI.
32:
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a definitive diagnosis. Diagnosis with a flexible bronchoscope, which allows the injury to be visualized directly, is the fastest and most reliable technique. In people with TBI, bronchoscopy may reveal that the airway is torn, or that the airways are blocked by blood, or that a bronchus has collapsed, obscuring more
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airway. If a bronchus is torn all the way around, the lung may collapse outward toward the chest wall (rather than inward, as it usually does in pneumothorax) because it loses the attachment to the bronchus which normally holds it toward the center. In a person lying face-up, the lung collapses toward the
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Rapid diagnosis and treatment are important in the care of TBI; if the injury is not diagnosed shortly after the injury, the risk of complications is higher. Bronchoscopy is the most effective method to diagnose, locate, and determine the severity of TBI, and it is usually the only method that allows
273:
Gunshot wounds are the commonest form of penetrating trauma that cause TBI. Less commonly, knife wounds and shrapnel from motor vehicle accidents can also penetrate the airways. Most injuries to the trachea occur in the neck, because the airways within the chest are deep and therefore well protected;
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of the right bronchus. Long-term survival of the injury was unknown in humans until a report was made of a person who survived in 1927. In 1931, a report made by Nissen described successful removal of a lung in a 12-year-old girl who had had narrowing of the bronchus due to the injury. Repair of TBI
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Throughout most of history, the mortality rate of TBI was thought to be 100%. However, in 1871 a healed TBI was noted in a duck that had been killed by a hunter, thus demonstrating that the injury could be survived, at least in the general sense. This report, made by
Winslow, was the first record in
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grows over the injured site, it can cause stenosis of the airway, after a week to a month. The granulation tissue must be surgically excised. Delayed diagnosis of a bronchial rupture increases risk of infection and lengthens hospital stay. People with a narrowed airway may develop dyspnea, coughing,
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of damaged tissue can shorten the trachea by as much as 50%. Repair of extensive tears can include sewing a flap of tissue taken from the membranes surrounding the heart or lungs (the pericardium and pleura, respectively) over the sutures to protect them. When lung tissue is destroyed as a result of
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and other tissues in the mid chest that surround the left main bronchus may protect it. Another possibility is that people with left main bronchus injuries are more likely to also have other deadly injuries and therefore die before reaching hospital, making them less likely to be included in studies
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A patient with traumatic complete disruption of the right bronchus. Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies
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Rupture of the trachea or bronchus is the most common type of blunt injury to the airway. It is difficult to determine the incidence of TBI: in as many as 30–80% of cases, death occurs before the person reaches a hospital, and these people may not be included in studies. On the other hand, some TBI
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can form at the suture site. Also, the sutured wound can tear again, as occurs when there is excessive pressure in the airways from ventilation. However, for people who do receive surgery soon after the injury to repair the lesion, outcome is usually good; the long-term outcome is good for over 90%
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Vehicle occupants who wear seat belts have a lower incidence of TBI after a motor vehicle accident. However, if the strap is situated across the front of the neck (instead of the chest), this increases the risk of tracheal injury. Design of medical instruments can be modified to prevent iatrogenic
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At least 30% of TBI are not discovered at first; this number may be as high as 50%. In about 10% of cases, TBI has no specific signs either clinically or on chest radiography, and its detection may be further complicated by concurrent injuries, since TBI tends to occur after high-energy accidents.
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is the initial imaging technique used to diagnose TBI. The film may not have any signs in an otherwise asymptomatic patient. Indications of TBI seen on radiographs include deformity in the trachea or a defect in the tracheal wall. Radiography may also show cervical emphysema, air in the tissues of
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occurs: the alveoli of the lung collapse. Lung tissue distal to a completely obstructed bronchiole often does not become infected. Because it is filled with mucus, this tissue remains functional. When the secretions are removed, the affected portion of the lung is commonly able to function almost
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The third mechanism occurs when the chest is compressed from front to back, causing it to widen from side to side. The lungs adhere to the chest wall because of the negative pressure between them and the pleural membranes lining the inside of the chest cavity; thus when the chest widens, they are
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appears in an X-ray to be sitting unusually high in the throat, it may be an indication that the trachea has been severed. TBI is also suspected if an endotracheal tube appears in an X-ray to be out of place, or if its cuff appears to be more full than normal or to protrude through a tear in the
205:
Signs and symptoms vary depending on what part of the tracheobronchial tree is injured and how severely it is damaged. There are no direct signs of TBI, but certain signs suggest the injury and raise a clinician's suspicion that it has occurred. Many of the signs and symptoms are also present in
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Most TBI that results from blunt trauma occurs within the chest. The most common tracheal injury is a tear near the carina or in the membranous wall of the trachea. In blunt chest trauma, TBI occurs within 2.5 cm of the carina 40–80% of the time. The injury is more common in the right main
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of the neck, usually resulting from vehicle crashes, can also injure the trachea, and trauma to the neck can crush the trachea against the vertebrae. A crush injury of the larynx or cervical trachea can occur in head-on collisions when the neck is hyperextended and strikes the steering wheel or
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have TBI. The incidence is estimated at 2% in blunt chest and neck trauma and 1–2% in penetrating chest trauma. Laryngotracheal injuries occur in 8% of patients with penetrating injury to the neck, and TBI occurs in 2.8% of blunt chest trauma deaths. In people with blunt trauma who do reach a
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Treatment of TBI varies based on the location and severity of injury and whether the patient is stable or having trouble breathing, but ensuring that the airway is patent so that the patient can breathe is always of paramount importance. Ensuring an open airway and adequate ventilation may be
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When airways are damaged, air can escape from them and be trapped in the surrounding tissues in the neck (subcutaneous emphysema) and mediastinum (pneumomediastinum); if it builds up to high enough pressures there, it can compress the airways. Massive air leaks from a ruptured airway can also
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of the skin) in the abdomen, chest, neck, and head. Subcutaneous emphysema, present in up to 85% of people with TBI, is particularly indicative of the injury when it is only in the neck. Air is trapped in the chest cavity outside the lungs (pneumothorax) in about 70% of TBI. Especially strong
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catching in a fold of membrane and tearing it as it is advanced downward through the airway. When an endotracheal tube tears the trachea, it typically does so at the posterior (back) membranous wall. Unlike TBI that results from blunt trauma, most iatrogenic injuries to the airway involve
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care or specialized treatment centers. Of those who reach the hospital alive but then die, most do so within the first two hours of arrival. The sooner a TBI is diagnosed, the higher the mortality rate; this is likely due to other accompanying injuries that prove fatal.
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longitudinal tears to the back of the trachea or tears on the side that pull the membranous part of the trachea away from the cartilage. Excessive pressure from the cuff of an endotracheal tube can reduce blood supply to the tissues of the trachea, leading to
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pulled apart. This creates tension at the carina; the airway tears if this tensile force exceeds its elasticity. This mechanism may be the cause of injury when the chest is crushed. Most TBI are probably due to a combination of these three mechanisms.
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can form. The latter type is associated with more minor signs; pneumothorax is small if it occurs at all, and although function is lost in the part of the lung supplied by the injured bronchus, unaffected parts of the lungs may be able to compensate.
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may occur as late complications. Years can pass before the condition is recognized. Some TBI are so small that they do not have significant clinical manifestations; they may never be noticed or diagnosed and may heal without intervention.
281:. The back of the trachea may be damaged during tracheotomy. TBI resulting from tracheal intubation (insertion of a tube into the trachea) is rare, and the mechanism by which it occurs is unclear. However, one likely mechanism involves an
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Most people with TBI who die do so within minutes of the injury, due to complications such as pneumothorax and insufficient airway and to other injuries that occurred at the same time. Most late deaths that occur in TBI are attributed to
270:; the injury is rare in low-impact mechanisms. Injuries of the trachea cause about 1% of traffic-related deaths. Other potential causes are falls from high places and injuries in which the chest is crushed. Explosions are another cause.
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of TBI (that is, it is diagnostic for TBI because it does not occur in other conditions); however it occurs only rarely. In as many as one in five cases, people with blunt trauma and TBI have no signs of the injury on chest X-ray.
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reflexively closes off the airways. When this pressure exceeds the elasticity of the tissues, they burst; thus the membranous part of the trachea is more commonly affected by this mechanism of injury than cartilaginous portions.
1700:
Trottier SJ, Hazard PB, Sakabu SA, Levine JH, Troop BR, Thompson JA, McNary R (May 1999). "Posterior tracheal wall perforation during percutaneous dilational tracheostomy: an investigation into its mechanism and prevention".
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of people who have TBI surgically repaired early in treatment. Even when surgery is performed years after the injury, the outlook is good, with low rates of death and disability and good chances of preserving lung function.
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that surround the front and sides of the structure; these rings are not closed and do not surround the back, which is made of membrane. The bronchi split into smaller branches and then to bronchioles that supply air to the
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the medical literature of a bronchus injury. In 1873, Seuvre made one of the earliest reports of TBI in the medical literature: a 74-year-old woman whose chest was crushed by a wagon wheel was found on autopsy to have an
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The mortality rate for people who reach a hospital alive was estimated at 30% in 1966; more recent estimates place this number at 9%. The number of people reaching a hospital alive has increased, perhaps due to improved
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The structures in the tracheobronchial tree are well protected, so it normally takes a large amount of force to injure them. In blunt trauma, TBI is usually the result of violent compression of the chest. Rapid
439:. Children have softer tracheas and a more elastic tracheobronchial trees than adults; this elasticity, which helps protect the structures from injury when they are compressed, may contribute to the lower
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Miñambres E, González-Castro A, Burón J, Suberviola B, Ballesteros MA, Ortiz-Melón F (June 2007). "Management of postintubation tracheobronchial rupture: our experience and a review of the literature".
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Although the mechanism is not well understood, TBI due to blunt trauma is widely thought to be caused by any combination of three possible mechanisms: an increase in pressure within the airways,
214:
has been found in up to 25%. However, isolated TBI does not usually cause profuse bleeding; if such bleeding is observed it is likely to be due to another injury such as a ruptured large
639:
While TBI may be managed without surgery, surgical repair of the tear is considered standard in the treatment of most TBI. It is required if a tear interferes with ventilation; if
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however, up to a quarter of TBI resulting from penetrating trauma occurs within the chest. Injury to the cervical trachea usually affects the anterior (front) part of the trachea.
1981:
Scaglione M, Romano S, Pinto A, Sparano A, Scialpi M, Rotondo A (September 2006). "Acute tracheobronchial injuries: Impact of imaging on diagnosis and management implications".
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is placed to rid the chest cavity of the air; it shows that air is continually leaking into the chest cavity from the site of the tear. Air can also be trapped in the
115:. Other injuries accompany TBI in about half of cases. Of those people with TBI who die, most do so before receiving emergency care, either from airway obstruction,
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laryngoscopy, may be employed to facilitate tracheal intubation. If the upper trachea is injured, an incision can be made in the trachea (tracheotomy) or the
313:(death of the tissue), scar formation, and ultimately stenosis. However, TBI due to inhalation, foreign body aspiration, and medical procedures is uncommon.
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consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).
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around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The
Macklin effect around the right lower
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the neck. X-rays may also show accompanying injuries and signs such as fractures and subcutaneous emphysema. If subcutaneous emphysema occurs and the
346:, as occurs in vehicle accidents, producing a shearing force. The lungs are mobile in the chest cavity but their movement is more restricted near the
2218:
GĂłmez-Caro AndrĂ©s A, Moradiellos DĂez FJ, AusĂn
Herrero P, DĂaz-HellĂn Gude V, LarrĂş Cabrero E, de Miguel Porch E, MartĂn De Nicolás JL (June 2005).
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Conti M, Pougeoise M, Wurtz A, Porte H, Fourrier F, Ramon P, Marquette CH (August 2006). "Management of postintubation tracheobronchial ruptures".
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dashboard; this has been called a "dashboard injury". The larynx and cervical trachea may also be injured in front-on collisions by the seat belt.
1935:
Wintermark M, Schnyder P, Wicky S (2001). "Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the "fallen lung" sign".
2016:
Atkins BZ, Abbate S, Fisher SR, Vaslef SN (January 2004). "Current management of laryngotracheal trauma: case report and literature review".
266:, but are more often the result of blunt trauma. TBI due blunt forces usually results from high-energy impacts such as falls from height and
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Wilderman MJ, Kaiser LR (2005). "Thoracic malignancy and pathophysiology". In Atluri P, Karakousis GC, Porrett PM, Kaiser LR (eds.).
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by a machine, and pumped back in. If a pneumothorax occurs, a chest tube may be inserted into the pleural cavity to remove the air.
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685:(MODS). If the condition is not recognized and treated early, serious complications are more likely to occur; for example,
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Weeks or months may go by before the injury is diagnosed, even though the injury is better known than it was in the past.
1249:
Rico FR, Cheng JD, Gestring ML, Piotrowski ES (April 2007). "Mechanical ventilation strategies in massive chest trauma".
831:"Chest computed tomography with multiplanar reformatted images for diagnosing traumatic bronchial rupture: a case report"
682:
2180:
Glazer ES, Meyerson SL (2008). "Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma".
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TBI, and medical practitioners can use techniques that reduce the risk of injury with procedures such as tracheotomy.
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706:, respiratory tract infection, and difficulty with clearing secretions. If the bronchiole is completely obstructed,
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detects over 90% of TBI resulting from blunt trauma, but neither X-ray nor CT are a replacement for bronchoscopy.
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Though rare, TBI is a serious condition; it may cause obstruction of the airway with resulting life-threatening
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can be used to ensure that the airway remains open. In severe cases, surgery may be necessary to repair a TBI.
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The trachea and bronchi form the tracheobronchial tree. The trachea is situated between the lower end of the
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Certain medical procedures can also injure the airways; these include tracheal intubation, bronchoscopy, and
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are present in 40–100%. The most common accompanying injury is esophageal perforation or rupture (known as
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A left main bronchus laceration, resulting in pneumothorax. Air is evacuated from the chest cavity with a
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742:
416:
793:), which occurs in as many as 43% of the penetrating injuries to the neck that cause tracheal injury.
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151:
48:
1121:
Barmada H, Gibbons JR (July 1994). "Tracheobronchial injury in blunt and penetrating chest trauma".
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Accompanying injuries often play a key role in the outcome. Injuries that may accompany TBI include
574:
226:, an abnormal, high-pitched breath sound indicating obstruction of the upper airway can also occur.
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in a patient with complete disruption of the right bronchus. Air leak was continual despite suction.
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778:
440:
423:. Anatomical structures that surround and protect the tracheobronchial tree include the lungs, the
262:
Injuries to the tracheobronchial tree within the chest may occur due to penetrating forces such as
250:). If air escapes from a penetrating injury to the neck, a definite diagnosis of TBI can be made.
170:(a condition where the voice can be hoarse, weak, or excessively breathy), coughing, and abnormal
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131:
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230:
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Gabor S, Renner H, Pinter H, Sankin O, Maier A, Tomaselli F, Smolle JĂĽttner FM (August 2001).
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Euathrongchit J, Thoongsuwan N, Stern EJ (March 2006). "Nonvascular mediastinal trauma".
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112:
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Karmy-Jones R, Wood DE (February 2007). "Traumatic injury to the trachea and bronchus".
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and the center of the chest, where it splits into the two bronchi at a ridge called the
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1960:
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Hwang JC, Hanowell LH, Grande CM (1996). "Peri-operative concerns in thoracic trauma".
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of the trachea may also be injured by inhalation of hot gases or harmful fumes such as
254:, a sound of crackling that occurs in time with the heartbeat, may also accompany TBI.
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40:
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and those that are not; in the former, air can leak from the hole in the airway and a
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Bronchial injuries are divided into those that are accompanied by a disruption of the
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Nakayama DK, Rowe MI (1988). "Intrathoracic tracheobronchial injuries in childhood".
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may threaten the airway, so alternative techniques to visualize the airway, such as
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929:"Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management"
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respectively; thus if the airways move, they can tear at these points of fixation.
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evidence that TBI has occurred is failure of a pneumothorax to resolve even when a
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Mussi A, Ambrogi MC, Ribechini A, Lucchi M, Menoni F, Angeletti CA (July 2001).
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119:, or from injuries to other vital organs. Of those who do reach a hospital, the
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and the back. This sign, described in 1969, is called fallen lung sign and is
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Wong EH, Knight S (May 2006). "Tracheobronchial injuries from blunt trauma".
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vary based on the location and severity of the injury; they commonly include
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showing disruption of the right main bronchus with abnormal lucency (arrow)
2220:"Successful conservative management in iatrogenic tracheobronchial injury"
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829:
Le Guen M, Beigelman C, Bouhemad B, WenjĂŻe Y, Marmion F, Rouby JJ (2007).
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when high pressure is required to ventilate the lungs. Techniques such as
218:. The patient may exhibit dysphonia or have diminished breath sounds, and
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injuries with similar injury mechanisms such as pneumothorax. Dyspnea and
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The
Surgical Review: An Integrated Basic and Clinical Science Study Guide
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359:
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632:), fluid management, and treatment of pneumonia are employed to improve
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142:, and damage to the lung tissue. Diagnosis involves procedures such as
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People with TBI are provided with supplemental oxygen and may need
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1459:. Hagerstown, MD: Lippincott Williams & Wilkins. p. 376.
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403:, the tiny air-filled sacs in the lungs responsible for absorbing
2271:. New York: McGraw-Hill, Medical Pub. Division. pp. 544–52.
672:(arrow) two weeks after surgery for a tracheobronchial laceration
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460:(white arrow). (d) Coronal view demonstrating multiple areas of
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2108:"Acute major airway injuries: clinical features and management"
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Complications may also occur with treatment; for example, a
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bronchus than the left, possibly because the former is near
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1980:
1815:
Granholm T, Farmer DL (March 2001). "The surgical airway".
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1211:
Tovar JA (February 2008). "The lung and pediatric trauma".
394:. The trachea is stabilized and kept open by rings made of
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1699:
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The second mechanism may occur when the chest is suddenly
2072:
1889:"Blunt tracheobronchial injuries: treatment and outcomes"
2015:
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1069:
Stark P (1995). "Imaging of tracheobronchial injuries".
1934:
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1600:"Indications for surgery in tracheobronchial ruptures"
2408:
2296:
2262:
2075:"Bronchial rupture in a young child: A case report"
2073:Porro GA, Roche CD, Banderker E, van As AB (2014).
1657:
1655:
1422:
130:and treat. Early diagnosis is important to prevent
1653:
1651:
1649:
1647:
1645:
1643:
1641:
1639:
1637:
1635:
1887:Kiser AC, O'Brien SM, Detterbeck FC (June 2001).
1482:Paidas CN. (September 15, 2006) Thoracic Trauma.
1376:
1374:
1372:
1370:
1368:
1366:
1364:
1362:
1360:
1358:
1356:
1354:
1352:
1350:
1348:
564:may be used to bypass a disruption in the airway.
2543:
2265:"Injury to the esophagus, trachea, and bronchus"
1346:
1344:
1342:
1340:
1338:
1336:
1334:
1332:
1330:
1328:
407:. An arbitrary division can be made between the
290:and potentially causing it to become ulcerated,
2267:. In Moore EJ, Feliciano DV, Mattox KL (eds.).
1930:
1928:
1926:
1924:
1632:
1454:
1380:
1011:Seminars in Thoracic and Cardiovascular Surgery
2179:
1976:
1974:
1814:
1120:
1009:Johnson SB (2008). "Tracheobronchial injury".
659:
2394:
1810:
1808:
1806:
1695:
1693:
1325:
593:may be used—blood is pumped out of the body,
210:are found in 76–100% of people with TBI, and
1921:
1288:
1284:
1282:
1280:
1004:
1002:
1000:
998:
996:
994:
992:
990:
988:
986:
984:
2175:
2173:
2171:
2169:
2167:
2165:
2163:
2161:
2147:
2145:
2143:
2112:European Journal of Cardio-Thoracic Surgery
2055:
2053:
2051:
2049:
2047:
1971:
1882:
1880:
1878:
1876:
1874:
1872:
1870:
1868:
1866:
1729:
1604:European Journal of Cardio-Thoracic Surgery
1116:
1114:
1112:
1110:
1108:
982:
980:
978:
976:
974:
972:
970:
968:
966:
964:
2401:
2387:
2213:
2211:
1864:
1862:
1860:
1858:
1856:
1854:
1852:
1850:
1848:
1846:
1803:
1770:
1768:
1690:
1558:
1556:
1554:
1552:
1550:
1548:
1546:
1506:
1418:
1416:
1414:
1412:
1190:
1188:
1186:
1184:
1182:
1180:
1178:
1176:
1174:
1172:
1064:
1062:
1060:
382:Diagram of the larynx, trachea and bronchi
30:
2263:Riley RD, Miller PR, Meredith JW (2004).
2235:
2123:
2090:
1904:
1817:Respiratory Care Clinics of North America
1615:
1562:
1502:
1500:
1498:
1478:
1476:
1450:
1448:
1446:
1277:
1206:
1204:
1170:
1168:
1166:
1164:
1162:
1160:
1158:
1156:
1154:
1152:
1058:
1056:
1054:
1052:
1050:
1048:
1046:
1044:
1042:
1040:
944:
856:
846:
616:. Employment of certain measures such as
2158:
2140:
2044:
1569:Cardiovascular/respiratory physiotherapy
1244:
1242:
1105:
961:
922:
920:
918:
916:
914:
912:
910:
908:
906:
904:
902:
900:
898:
896:
824:
822:
820:
663:
599:
555:
450:
377:
222:is common. Coughing may be present, and
185:
154:to visualize the tracheobronchial tree.
2208:
1843:
1765:
1591:
1543:
1409:
1008:
926:
894:
892:
890:
888:
886:
884:
882:
880:
878:
876:
2544:
2009:
1739:European Journal of Emergency Medicine
1495:
1473:
1443:
1201:
1149:
1037:
2382:
2099:
1239:
1210:
1068:
817:
181:
1425:Baillière's Clinical Anaesthesiology
1291:International Anesthesiology Clinics
873:
1664:Radiologic Clinics of North America
683:multiple organ dysfunction syndrome
16:Damage to the tracheobronchial tree
13:
539:that determine rates of injuries.
246:, the center of the chest cavity (
14:
2563:
2292:
2030:10.1097/01.TA.0000082650.62207.92
1571:. St. Louis: Mosby. p. 217.
534:, which may injure it. Also, the
505:
100:, inhalation of harmful fumes or
2237:10.1016/j.athoracsur.2004.10.006
1521:10.1111/j.1445-2197.2006.03738.x
1303:10.1097/00004311-198802610-00009
1225:10.1053/j.sempedsurg.2007.10.008
1083:10.1097/00005382-199522000-00006
618:Positive end-expiratory pressure
229:Damage to the airways can cause
2066:
722:
636:(the elasticity of the lungs).
419:, an opening at the top of the
126:TBI is frequently difficult to
2224:The Annals of Thoracic Surgery
1893:The Annals of Thoracic Surgery
1395:10.1016/j.thorsurg.2007.03.005
933:Anaesthesia and Intensive Care
927:Chu CP, Chen PP (April 2002).
193:of both lungs (large arrows),
1:
2256:
2182:Journal of Surgical Education
2125:10.1016/S1010-7940(01)00702-3
2118:(1): 46–51, discussion 51–2.
1983:European Journal of Radiology
1906:10.1016/S0003-4975(00)02453-X
1829:10.1016/S1078-5337(05)70020-4
1617:10.1016/S1010-7940(01)00798-9
1437:10.1016/S0950-3501(96)80009-2
1213:Seminars in Pediatric Surgery
1023:10.1053/j.semtcvs.2007.09.001
542:
2092:10.1016/j.injury.2014.01.009
1751:10.1097/MEJ.0b013e3280bef8f0
551:
446:
354:and carina are fixed to the
316:
174:. In the emergency setting,
7:
2194:10.1016/j.jsurg.2008.06.006
1995:10.1016/j.ejrad.2006.04.026
1492:Retrieved on June 13, 2007.
1071:Journal of Thoracic Imaging
660:Prognosis and complications
473:(lower) bronchi from view.
427:, large blood vessels, the
140:respiratory tract infection
138:(narrowing) of the airway,
10:
2568:
946:10.1177/0310057X0203000204
796:
373:
2486:
2420:
2352:
2300:
1676:10.1016/j.rcl.2005.10.001
1263:10.1016/j.ccc.2006.12.007
257:
152:x-ray computed tomography
113:respiratory insufficiency
55:
49:x-ray computed tomography
38:
29:
24:
2439:Traumatic aortic rupture
1715:10.1378/chest.115.5.1383
1563:Smith M, Ball V (1998).
1383:Thoracic Surgery Clinics
810:
779:traumatic aortic rupture
759:fractures of the sternum
294:, and, later, narrowed.
166:(difficulty breathing),
80:structure involving the
2524:Tracheobronchial injury
2490:lower respiratory tract
1789:10.1378/chest.130.2.412
783:injuries to the abdomen
268:motor vehicle accidents
123:may be as high as 30%.
108:of liquids or objects.
70:Tracheobronchial injury
25:Tracheobronchial injury
1509:ANZ Journal of Surgery
1135:10.1378/chest.106.1.74
673:
614:mechanical ventilation
609:
591:cardiopulmonary bypass
565:
465:
383:
231:subcutaneous emphysema
202:
199:subcutaneous emphysema
96:trauma to the neck or
88:). It can result from
39:Reconstruction of the
2529:Diaphragmatic rupture
2444:Thoracic aorta injury
2018:The Journal of Trauma
1949:10.1007/s003300000581
1251:Critical Care Clinics
667:
603:
583:cricothyroid membrane
559:
454:
381:
189:
74:tracheobronchial tree
2519:Pulmonary laceration
2459:Myocardial contusion
732:patients treated in
634:pulmonary compliance
622:pulmonary barotrauma
443:of TBI in children.
233:(air trapped in the
208:respiratory distress
2514:Pulmonary contusion
2155:(2004). pp. 550–51.
751:pulmonary contusion
648:TBI complications,
305:. This can lead to
235:subcutaneous tissue
176:tracheal intubation
2478:Myocardial rupture
2424:circulatory system
2353:External resources
2063:(2004). pp. 548–9.
1937:European Radiology
1670:(2): 251–8, viii.
1257:(2): 299–315, xi.
1198:(2004). pp. 544–7.
791:Boerhaave syndrome
771:Spinal cord injury
699:granulation tissue
674:
610:
566:
466:
384:
203:
197:(small arrow) and
182:Signs and symptoms
62:Emergency medicine
2537:
2536:
2468:Cardiac tamponade
2376:
2375:
1565:"Thoracic trauma"
562:endotracheal tube
356:thyroid cartilage
352:cricoid cartilage
350:. Areas near the
283:endotracheal tube
248:pneumomediastinum
212:coughing up blood
195:pneumomediastinum
72:is damage to the
67:
66:
19:Medical condition
2559:
2509:Hemopneumothorax
2403:
2396:
2389:
2380:
2379:
2298:
2297:
2288:
2286:
2285:
2250:
2249:
2239:
2215:
2206:
2205:
2177:
2156:
2149:
2138:
2137:
2127:
2103:
2097:
2096:
2094:
2070:
2064:
2057:
2042:
2041:
2013:
2007:
2006:
1978:
1969:
1968:
1932:
1919:
1918:
1908:
1884:
1841:
1840:
1812:
1801:
1800:
1772:
1763:
1762:
1733:
1727:
1726:
1697:
1688:
1687:
1659:
1630:
1629:
1619:
1595:
1589:
1588:
1586:
1585:
1560:
1541:
1540:
1504:
1493:
1480:
1471:
1470:
1452:
1441:
1440:
1420:
1407:
1406:
1378:
1323:
1322:
1286:
1275:
1274:
1246:
1237:
1236:
1208:
1199:
1192:
1147:
1146:
1118:
1103:
1102:
1066:
1035:
1034:
1006:
959:
958:
948:
924:
871:
870:
860:
850:
826:
626:pulmonary toilet
134:, which include
34:
22:
21:
2567:
2566:
2562:
2561:
2560:
2558:
2557:
2556:
2542:
2541:
2538:
2533:
2488:
2482:
2473:Hemopericardium
2463:Commotio cordis
2422:
2416:
2407:
2377:
2372:
2371:
2348:
2347:
2309:
2295:
2283:
2281:
2279:
2259:
2254:
2253:
2216:
2209:
2178:
2159:
2150:
2141:
2104:
2100:
2071:
2067:
2058:
2045:
2014:
2010:
1979:
1972:
1933:
1922:
1885:
1844:
1813:
1804:
1773:
1766:
1734:
1730:
1698:
1691:
1660:
1633:
1596:
1592:
1583:
1581:
1579:
1561:
1544:
1505:
1496:
1481:
1474:
1467:
1453:
1444:
1421:
1410:
1379:
1326:
1287:
1278:
1247:
1240:
1209:
1202:
1193:
1150:
1119:
1106:
1067:
1038:
1007:
962:
925:
874:
827:
818:
813:
799:
725:
662:
554:
545:
510:Lesions can be
508:
449:
421:thoracic cavity
415:trachea at the
376:
319:
260:
220:rapid breathing
184:
20:
17:
12:
11:
5:
2565:
2555:
2554:
2535:
2534:
2532:
2531:
2526:
2521:
2516:
2511:
2506:
2501:
2495:
2493:
2484:
2483:
2481:
2480:
2475:
2470:
2465:
2449:
2448:
2447:
2446:
2429:
2427:
2418:
2417:
2406:
2405:
2398:
2391:
2383:
2374:
2373:
2370:
2369:
2357:
2356:
2354:
2350:
2349:
2346:
2345:
2330:
2310:
2305:
2304:
2302:
2301:Classification
2294:
2293:External links
2291:
2290:
2289:
2277:
2258:
2255:
2252:
2251:
2207:
2157:
2139:
2098:
2065:
2043:
2008:
1970:
1920:
1899:(6): 2059–65.
1842:
1802:
1764:
1728:
1689:
1631:
1610:(2): 399–404.
1590:
1577:
1542:
1494:
1472:
1465:
1442:
1431:(1): 123–153.
1408:
1324:
1276:
1238:
1200:
1148:
1104:
1036:
960:
872:
848:10.1186/cc6109
815:
814:
812:
809:
798:
795:
734:trauma centers
724:
721:
691:bronchiectasis
661:
658:
587:cricothyrotomy
553:
550:
544:
541:
507:
506:Classification
504:
458:pulmonary vein
448:
445:
433:thoracic spine
417:thoracic inlet
375:
372:
324:hyperextension
318:
315:
299:mucosal lining
264:gunshot wounds
259:
256:
191:Pneumothoraces
183:
180:
121:mortality rate
117:exsanguination
65:
64:
59:
53:
52:
36:
35:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2564:
2553:
2550:
2549:
2547:
2540:
2530:
2527:
2525:
2522:
2520:
2517:
2515:
2512:
2510:
2507:
2505:
2502:
2500:
2497:
2496:
2494:
2491:
2485:
2479:
2476:
2474:
2471:
2469:
2466:
2464:
2460:
2457:
2455:
2451:
2450:
2445:
2442:
2441:
2440:
2437:
2435:
2431:
2430:
2428:
2425:
2419:
2415:
2411:
2404:
2399:
2397:
2392:
2390:
2385:
2384:
2381:
2368:
2364:
2363:
2359:
2358:
2355:
2351:
2344:
2340:
2339:
2335:
2331:
2329:
2325:
2321:
2320:
2316:
2312:
2311:
2308:
2303:
2299:
2280:
2278:0-07-137069-2
2274:
2270:
2266:
2261:
2260:
2247:
2243:
2238:
2233:
2230:(6): 1872–8.
2229:
2225:
2221:
2214:
2212:
2203:
2199:
2195:
2191:
2187:
2183:
2176:
2174:
2172:
2170:
2168:
2166:
2164:
2162:
2154:
2148:
2146:
2144:
2135:
2131:
2126:
2121:
2117:
2113:
2109:
2102:
2093:
2088:
2084:
2080:
2076:
2069:
2062:
2056:
2054:
2052:
2050:
2048:
2039:
2035:
2031:
2027:
2024:(1): 185–90.
2023:
2019:
2012:
2004:
2000:
1996:
1992:
1989:(3): 336–43.
1988:
1984:
1977:
1975:
1966:
1962:
1958:
1954:
1950:
1946:
1943:(3): 409–11.
1942:
1938:
1931:
1929:
1927:
1925:
1916:
1912:
1907:
1902:
1898:
1894:
1890:
1883:
1881:
1879:
1877:
1875:
1873:
1871:
1869:
1867:
1865:
1863:
1861:
1859:
1857:
1855:
1853:
1851:
1849:
1847:
1838:
1834:
1830:
1826:
1822:
1818:
1811:
1809:
1807:
1798:
1794:
1790:
1786:
1782:
1778:
1771:
1769:
1760:
1756:
1752:
1748:
1744:
1740:
1732:
1724:
1720:
1716:
1712:
1709:(5): 1383–9.
1708:
1704:
1696:
1694:
1685:
1681:
1677:
1673:
1669:
1665:
1658:
1656:
1654:
1652:
1650:
1648:
1646:
1644:
1642:
1640:
1638:
1636:
1627:
1623:
1618:
1613:
1609:
1605:
1601:
1594:
1580:
1578:0-7234-2595-7
1574:
1570:
1566:
1559:
1557:
1555:
1553:
1551:
1549:
1547:
1538:
1534:
1530:
1526:
1522:
1518:
1514:
1510:
1503:
1501:
1499:
1491:
1487:
1486:
1479:
1477:
1468:
1466:0-7817-5641-3
1462:
1458:
1451:
1449:
1447:
1438:
1434:
1430:
1426:
1419:
1417:
1415:
1413:
1404:
1400:
1396:
1392:
1388:
1384:
1377:
1375:
1373:
1371:
1369:
1367:
1365:
1363:
1361:
1359:
1357:
1355:
1353:
1351:
1349:
1347:
1345:
1343:
1341:
1339:
1337:
1335:
1333:
1331:
1329:
1320:
1316:
1312:
1308:
1304:
1300:
1296:
1292:
1285:
1283:
1281:
1272:
1268:
1264:
1260:
1256:
1252:
1245:
1243:
1234:
1230:
1226:
1222:
1218:
1214:
1207:
1205:
1197:
1191:
1189:
1187:
1185:
1183:
1181:
1179:
1177:
1175:
1173:
1171:
1169:
1167:
1165:
1163:
1161:
1159:
1157:
1155:
1153:
1144:
1140:
1136:
1132:
1128:
1124:
1117:
1115:
1113:
1111:
1109:
1100:
1096:
1092:
1088:
1084:
1080:
1077:(3): 206–19.
1076:
1072:
1065:
1063:
1061:
1059:
1057:
1055:
1053:
1051:
1049:
1047:
1045:
1043:
1041:
1032:
1028:
1024:
1020:
1016:
1012:
1005:
1003:
1001:
999:
997:
995:
993:
991:
989:
987:
985:
983:
981:
979:
977:
975:
973:
971:
969:
967:
965:
956:
952:
947:
942:
939:(2): 145–52.
938:
934:
930:
923:
921:
919:
917:
915:
913:
911:
909:
907:
905:
903:
901:
899:
897:
895:
893:
891:
889:
887:
885:
883:
881:
879:
877:
868:
864:
859:
854:
849:
844:
840:
836:
835:Critical Care
832:
825:
823:
821:
816:
808:
805:
794:
792:
788:
784:
780:
776:
775:facial trauma
772:
768:
764:
760:
756:
752:
747:
744:
738:
735:
731:
720:
717:
712:
709:
705:
700:
695:
692:
688:
684:
680:
671:
666:
657:
655:
651:
650:pneumonectomy
646:
642:
641:mediastinitis
637:
635:
631:
627:
623:
619:
615:
607:
602:
598:
596:
592:
588:
584:
580:
576:
572:
563:
558:
549:
540:
537:
533:
527:
524:
520:
515:
513:
503:
499:
497:
492:
491:pathognomonic
488:
483:
478:
474:
472:
463:
459:
453:
444:
442:
438:
434:
430:
426:
422:
418:
414:
410:
409:intrathoracic
406:
402:
397:
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308:
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265:
255:
253:
252:Hamman's sign
249:
245:
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236:
232:
227:
225:
221:
217:
213:
209:
200:
196:
192:
188:
179:
177:
173:
172:breath sounds
169:
165:
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157:
153:
149:
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137:
133:
132:complications
129:
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87:
83:
79:
75:
71:
63:
60:
58:
54:
50:
46:
42:
37:
33:
28:
23:
2552:Chest trauma
2539:
2523:
2499:Pneumothorax
2452:
2432:
2412:, excluding
2410:Chest injury
2360:
2332:
2313:
2282:. Retrieved
2268:
2227:
2223:
2188:(4): 302–8.
2185:
2181:
2152:
2115:
2111:
2101:
2085:(3): 25–27.
2082:
2079:Injury Extra
2078:
2068:
2060:
2021:
2017:
2011:
1986:
1982:
1940:
1936:
1896:
1892:
1823:(1): 13–23.
1820:
1816:
1783:(2): 412–8.
1780:
1776:
1745:(3): 177–9.
1742:
1738:
1731:
1706:
1702:
1667:
1663:
1607:
1603:
1593:
1582:. Retrieved
1568:
1515:(5): 414–5.
1512:
1508:
1483:
1456:
1428:
1424:
1389:(1): 35–46.
1386:
1382:
1294:
1290:
1254:
1250:
1216:
1212:
1195:
1126:
1122:
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1070:
1014:
1010:
936:
932:
838:
834:
800:
785:, lung, and
748:
739:
726:
723:Epidemiology
713:
696:
675:
638:
628:(removal of
611:
571:laryngoscopy
567:
546:
528:
523:pneumothorax
516:
509:
500:
475:
467:
385:
368:
364:
341:
329:
320:
309:(swelling),
303:chlorine gas
296:
276:
272:
261:
228:
216:blood vessel
204:
144:bronchoscopy
125:
110:
69:
68:
2421:Cardiac and
1297:(1): 42–9.
1219:(1): 53–9.
1129:(1): 74–8.
1017:(1): 52–7.
743:prehospital
708:atelectasis
645:Debridement
496:CT scanning
477:Chest x-ray
360:pericardium
344:decelerated
279:tracheotomy
244:mediastinum
148:radiography
94:penetrating
2504:Hemothorax
2284:2008-06-15
2257:References
1584:2008-06-12
841:(5): R94.
755:laceration
730:polytrauma
668:Bronchial
630:secretions
606:chest tube
595:oxygenated
575:fiberoptic
543:Prevention
512:transverse
482:hyoid bone
435:, and the
240:chest tube
106:aspiration
2414:fractures
2367:radio/706
2362:eMedicine
1490:eMedicine
767:clavicles
716:granuloma
687:pneumonia
654:lobectomy
552:Treatment
532:vertebrae
487:diaphragm
447:Diagnosis
441:incidence
425:esophagus
396:cartilage
317:Mechanism
168:dysphonia
57:Specialty
2546:Category
2492:injuries
2487:Lung and
2434:vascular
2426:injuries
2246:15919275
2202:18707665
2134:11423273
2038:14749588
2003:16782296
1957:11288843
1915:11426809
1837:11584802
1797:16899839
1759:17473617
1723:10334157
1684:16500207
1626:11463564
1537:21354960
1529:16768706
1485:ped/3001
1403:17650695
1271:17368173
1233:18158142
1031:18420127
955:12002920
867:17767714
804:avulsion
704:wheezing
670:stenosis
462:alveolar
429:rib cage
413:cervical
358:and the
332:shearing
311:necrosis
292:infected
288:ischemia
160:symptoms
136:stenosis
128:diagnose
1965:6767450
1319:1005862
1311:3283046
1143:8020323
1099:9683995
1091:7674433
858:2556736
797:History
437:sternum
401:alveoli
374:Anatomy
336:glottis
224:stridor
164:dyspnea
86:bronchi
82:trachea
45:bronchi
41:trachea
2343:862.21
2275:
2269:Trauma
2244:
2200:
2153:et al.
2151:Riley
2132:
2061:et al.
2059:Riley
2036:
2001:
1963:
1955:
1913:
1835:
1795:
1757:
1721:
1682:
1624:
1575:
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1527:
1463:
1401:
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1309:
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1231:
1196:et al.
1194:Riley
1141:
1097:
1089:
1029:
953:
865:
855:
757:; and
679:sepsis
519:pleura
471:distal
431:, the
405:oxygen
392:carina
388:larynx
258:Causes
150:, and
78:airway
2454:heart
2328:S27.5
2324:S27.4
1961:S2CID
1777:Chest
1703:Chest
1533:S2CID
1315:S2CID
1123:Chest
1095:S2CID
811:Notes
579:video
536:aorta
348:hilum
307:edema
156:Signs
104:, or
102:smoke
98:chest
90:blunt
76:(the
47:with
2338:9-CM
2273:ISBN
2242:PMID
2198:PMID
2130:PMID
2034:PMID
1999:PMID
1953:PMID
1911:PMID
1833:PMID
1793:PMID
1755:PMID
1719:PMID
1680:PMID
1622:PMID
1573:ISBN
1525:PMID
1461:ISBN
1399:PMID
1307:PMID
1267:PMID
1229:PMID
1139:PMID
1087:PMID
1027:PMID
951:PMID
863:PMID
787:head
765:and
763:ribs
753:and
689:and
411:and
297:The
158:and
84:and
43:and
2334:ICD
2315:ICD
2232:doi
2190:doi
2120:doi
2087:doi
2026:doi
1991:doi
1945:doi
1901:doi
1825:doi
1785:doi
1781:130
1747:doi
1711:doi
1707:115
1672:doi
1612:doi
1517:doi
1488:at
1433:doi
1391:doi
1299:doi
1259:doi
1221:doi
1131:doi
1127:106
1079:doi
1019:doi
941:doi
853:PMC
843:doi
697:If
681:or
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560:An
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