Traumatic trachea and main bronchus injury

Introduction to traumatic trachea and main bronchial injury Traumatic trachea, bronchial injury refers to the external force directly acting on the neck or trachea, can also be caused by indirect external force caused by closed trauma of the chest, often combined with other more serious trauma, the diagnosis of tracheal and bronchial trauma is delayed, It often causes immediate and early death of the patient. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific people Mode of infection: non-infectious complication:

Causes of traumatic trachea and main bronchial injury

(1) Causes of the disease

Penetrating trauma, sharp injury and blunt trauma can cause tracheobronchial injury. Penetrating tracheal injury is usually in the neck. The trachea is located in the center of the thoracic cavity. It is vulnerable to penetrating wounds caused by shooting or other causes. Blunt trauma can damage the trachea. In the neck, a strong external impact is enough to cause damage to the trachea. First, the rupture point is at the joint of the main bronchial cartilage and the membranous part, and the right side is mostly in the main bronchial mediastinal pleural coating. Between the upper bronchial opening and the upper bronchial opening, the left side is mostly at the lower edge of the main bronchial aortic arch. The typical tear is annular and incomplete. The rare tear is a tear perpendicular to the connective line of the trachea and the cartilage ring. Complete disconnection is common, and tracheal disconnection is rare. Bertelsen and Howitz reported that of the 1178 patients who died of chest closed trauma, only 33 had combined tracheal injury.

(two) pathogenesis

1. The trachea of various traumatic injuries in the neck can maintain ventilation in the early stage of the injury. With the bleeding of the tracheobronchial bronchus, breathing difficulties will soon appear. Bronchoscopy can be seen that the trachea is full of bloody secretions.

2. The pathogenesis of tracheal and bronchial injuries caused by blunt trauma of the chest is not fully understood. There are roughly three mechanisms:

1 The thorax is elastic. When the current thorax is subjected to a strong external force, its transverse diameter increases significantly. The lungs move to the sides respectively. The trachea moves forward due to inertia, and the rebound force causes the outward pulling force of the tracheal protuberance. Tracheal tear,

2 In the case of trauma, the glottis is closed, holding the breath, and the pressure in the tracheal cavity rises suddenly, causing the trachea to burst.

3 In the case of trauma, a large shear force appears at the fixed point of the bronchus.

Traumatic trachea and main bronchial injury prevention

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Traumatic trachea and complications of main bronchial injury Complication

The disease is usually an open injury, so it is particularly susceptible to infection, and the trachea is very close to the lung tissue, so it can cause lung tissue infection. Patients with pneumonia may have cough, chest pain, high fever, and difficulty breathing. In the early stage of the injury, because the trachea and the outside world figured out, the filtration of the nasopharyngeal part of the breath was also one of the causes of the pulmonary infection. Secondly, there may be complications such as blood chest and pneumothorax.

Traumatic trachea and main bronchial injury symptoms common symptoms atelectasis tension pneumothorax hemoptysis dyspnea

Bronchial rupture after chest trauma is mainly manifested as dyspnea in the clinic, subcutaneous or mediastinal emphysema in the neck, pneumothorax or tension pneumothorax, blood pneumothorax, cyanosis, pneumothorax patients after the chest drainage tube, due to inhaled gas directly from the chest Tube overflow, but worsened the difficulty of breathing, bronchial injury combined with different degrees of bleeding, when the patient came to the emergency room, most patients with bronchial bleeding has stopped or not, only when the bleeding, the patient has hemoptysis symptoms, The above clinical symptoms depend on the location, size, tearing of the bronchial vessels and the integrity of the mediastinal pleura.

It has been suggested that there are two types according to the injury site of traumatic bronchial rupture, that is, the proximal end of the injured bronchus is open to the pleural cavity (type I), and the proximal end is not connected to the pleural cavity (type II), type I bronchial breakage. Pneumothorax, hemothorax, etc. are prone to occur, while type II bronchial rupture is mainly mediastinal emphysema. When bronchial rupture, part of lung ventilatory function is lost, resulting in large blood shunt, so dyspnea and cyanosis in both types of bronchial rupture Will appear.

Bronchial rupture can be divided into partial rupture and complete rupture. The proximal end of the rupture can communicate with the pleural cavity or not with the pleural cavity. The bronchial partial fracture airway still has ventilation, but the drainage is blocked and prone to infection. If the treatment is not timely, a lung abscess or a pneumothorax will occur, and the main bronchus will be completely broken. The two stumps are separated by a few centimeters. They are isolated from the outside due to the distal contraction of the fracture or are quickly closed by secretions. It is characterized by complete atelectasis on one side, and complicated tracheal stenosis in the later stage. There are few reports of residual lung infection, which can be maintained for several years, ten years. When the surgery is stopped, the retained secretions can still be absorbed. There are many types of tears in the re-expansion, trachea and main bronchi.

Traumatic trachea and main bronchial injury examination

1. X-ray examination The main X-ray changes in the early stage of main bronchial rupture are massive pneumothorax, subcutaneous and mediastinal, deep cervical emphysema, upper thoracic rib fracture, main bronchial truncation or discontinuity, collapse of lung fall sign and lung floating sign, ie The upper edge of the inferior lung descends below the level of the hilar. In the advanced stage, the diagnosis relies mainly on the bronchial bifurcation layer image and bronchial lipiodol angiography, which can clearly show the blind pocket-shaped proximal or narrow bronchial segment. According to reports in the literature, 25% to 68% of patients have delayed diagnosis due to the lack of typical clinical signs. The reason is that the tissue surrounding the affected bronchi maintains the connection between the two ends of the bronchus, so that the affected lung can still be ventilated, so in the early stage of trauma If you encounter refractory pneumothorax after blunt trauma, consider the possibility of bronchial rupture.

2. Tracheal CT tomography can find direct signs of tracheal rupture, deformation and discontinuity of the tracheal translucent band, and even signs of dislocation.

3. Fiberoptic bronchoscopy can confirm the location and extent of tracheobronchial rupture and stenosis, and it has a positive diagnostic value for early or advanced cases, while the negative test results can rule out the presence of bronchial rupture and severe hemoptysis after chest injury. It should not be ignored, even if there are no other indications of tracheal and bronchial disconnection, bronchoscopy should be considered immediately.

Diagnosis and diagnosis of traumatic trachea and main bronchial injury

For patients with severe chest blunt trauma, there are severe dyspnea and cyanosis in the emergency department. It is important to find tension pneumothorax, pneumothorax, mediastinal emphysema and lower neck emphysema. Even if there is no pneumothorax, it is also on the chest X-ray. The most sensitive sign of tracheal rupture, the most reliable method for diagnosing tracheal rupture is fiberoptic bronchoscopy. All patients with clinically suspected tracheal injury should be diagnosed with fiberoptic bronchoscopy immediately if circumstances permit. Anti-delay diagnosis caused death or other problems. Tension pneumothorax and pneumothorax were placed in the thoracic closed drainage. It was found that a large amount of gas continued to leak out, which was aggravated with the inhalation action. According to the above signs, the diagnosis can be confirmed. The chest radiograph confirms the diagnosis, and for most cases without concurrent hemoptysis, there is no need to rush to do bronchoscopy or other examinations.

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