1
|
Villanueva Campos A, Oikonomou A, Jiménez-Juan L, Gorospe Sarasúa L, Villanueva Marcos A. Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography. RADIOLOGIA 2023; 65:258-268. [PMID: 37268368 DOI: 10.1016/j.rxeng.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/16/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE About 60% of multiple trauma patients have thoracic trauma, and thoracic trauma results in the death of 10% of these patients. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute disease, and it helps in the management and prognostic evaluation of patients with high-impact trauma. This paper aims to show the practical points that are key for diagnosing severe non-cardiovascular thoracic trauma by CT. CONCLUSION Knowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings.
Collapse
Affiliation(s)
- A Villanueva Campos
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A Oikonomou
- Departamento de Radiología, Sunnybrook Health Sciences Centre, Universidad de Toronto, Toronto, Canada
| | - L Jiménez-Juan
- Departamento de Radiología, St. Micheal's Hospital, Universidad de Toronto, Toronto, Canada
| | - L Gorospe Sarasúa
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Villanueva Marcos
- Departamento de Radiología, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom
| |
Collapse
|
2
|
Passera E, Orlandi R, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Raveglia F. Post-intubation iatrogenic tracheobronchial injuries: The state of art. Front Surg 2023; 10:1125997. [PMID: 36860949 PMCID: PMC9968843 DOI: 10.3389/fsurg.2023.1125997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Iatrogenic tracheobronchial injury (ITI) is an infrequent but potentially life-threatening disease, with significant morbidity and mortality rates. Its incidence is presumably underestimated since several cases are underrecognized and underreported. Causes of ITI include endotracheal intubation (EI) or percutaneous tracheostomy (PT). Most frequent clinical manifestations are subcutaneous emphysema, pneumomediastinum and unilateral or bilateral pneumothorax, even if occasionally ITI can occur without significant symptoms. Diagnosis mainly relies on clinical suspicion and CT scan, although flexible bronchoscopy remains the gold standard, allowing to identify location and size of the injury. EI and PT related ITIs more commonly consist of longitudinal tear involving the pars membranacea. Based on the depth of tracheal wall injury, Cardillo and colleagues proposed a morphologic classification of ITIs, attempting to standardize their management. Nevertheless, in literature there are no unambiguous guidelines on the best therapeutic modality: management and its timing remain controversial. Historically, surgical repair was considered the gold standard, mainly in high-grade lesions (IIIa-IIIb), carrying high morbi-mortality rates, but currently the development of promising endoscopic techniques through rigid bronchoscopy and stenting could allow for bridge treatment, delaying surgical approach after improving general conditions of the patient, or even for definitive repair, ensuring lower morbi-mortality rates especially in high-risk surgical candidates. Our perspective review will cover all the above issues, aiming at providing an updated and clear diagnostic-therapeutic pathway protocol, which could be applied in case of unexpected ITI.
Collapse
Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| |
Collapse
|
3
|
Traumatismo torácico grave no cardiovascular: Claves diagnósticas en tomografía computarizada. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
4
|
Moser JB, Stefanidis K, Vlahos I. Imaging Evaluation of Tracheobronchial Injuries. Radiographics 2020; 40:515-528. [DOI: 10.1148/rg.2020190171] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Joanna B. Moser
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Stefanidis
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ioannis Vlahos
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
5
|
Wei P, Yan D, Huang J, Dong L, Zhao Y, Rong F, Li J, Tang W, Li J. Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review. BMC Anesthesiol 2019; 19:149. [PMID: 31399024 PMCID: PMC6689158 DOI: 10.1186/s12871-019-0812-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Tracheobronchial lacerations from trauma can be life-threatening and present significant challenges for safe anesthetic management. Early recognition of tracheal injuries and prompt airway control can be lifesaving. Case presentation A 56-year-old man with no significant medical history presented with difficulty breathing after a blunt trauma to his chest to the emergency room and was diagnosed with dislocation of the first rib and tracheal laceration after a chest tomography (CT) study. Subcutaneous emphysema in neck area quickly worsened indicating continuous air leak. Emergent surgical repair was scheduled. General anesthesia with maintaining spontaneous ventilation was performed and a 5.5 mm endotracheal tube was placed under the guidance of flexible bronchoscopy. Depth of anesthesia was maintained to achieve a Bispectral Index Score of 40–60. Once the offending first rib was removed, a 7.5 mm endotracheal tube was inserted distal to the laceration site with the guidance of flexible bronchoscopy. Once confirmed location of the endotracheal tube, cisatracurium was administered intravenously and the patient was managed on mechanical ventilation with interval positive pressure ventilation. The operation was successful and he was transferred to the ICU intubated. He then received elective surgical repairs for sternum fracture, multiple rib fractures and hemopneumothorax under general anesthesia on day 5 after the first surgery and was extubated on postoperative day 7. The subsequent course was uneventful. Comprehensive rehabilitation was done for 2 weeks and he was discharged home on postoperative day 41. Conclusions Early diagnosis and multidisciplinary collaborations are keys to the successful management of this patient. Flexible bronchoscopy is particularly useful in airway management for urgent trachea tracheal laceration repair.
Collapse
Affiliation(s)
- Penghui Wei
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Dong Yan
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Lili Dong
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Ying Zhao
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Fei Rong
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Jing Li
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China
| | - Wenxi Tang
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China.
| | - Jianjun Li
- Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China.
| |
Collapse
|
6
|
Abstract
Thoracic injury results from penetrating and blunt trauma and is a major contributor to overall trauma morbidity and mortality in the United States. Modern imaging algorithms utilize ultrasound, chest radiograph, and computed tomography with intravenous contrast to accurately diagnose and effectively treat patients with acute thoracic trauma. This review focuses on the etiologies, signs and symptoms, imaging, and management of several life-threatening thoracic injuries including tracheobronchial rupture, pulmonary parenchymal injury, hemothorax, pneumothorax, diaphragmatic rupture, and axial skeleton injury.
Collapse
Affiliation(s)
- Alex Newbury
- Department of Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Jon D Dorfman
- Department of Surgery University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Hao S Lo
- Department of Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA.
| |
Collapse
|
7
|
Acevedo E, Sjoholm LO, Santora T, Goldberg AJ. A Review of the Role and Utility of Chest Computed Tomography in Penetrating Chest Trauma. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Abstract
OBJECTIVE Recent technical advances, including the routine use of CT thin sections and techniques such as 2D minimum-intensity-projection and 3D volume images, have increased our ability to detect large airways diseases. Furthermore, dedicated CT protocols allow the evaluation of dynamic airway dysfunction. CONCLUSION With diseases of the large airways more commonly seen in daily practice, it is important that radiologists be familiar with the appearances, differential diagnosis, and clinical implications of these entities.
Collapse
|
9
|
CT imaging of blunt chest trauma. Insights Imaging 2011; 2:281-295. [PMID: 22347953 PMCID: PMC3259405 DOI: 10.1007/s13244-011-0072-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/28/2010] [Accepted: 01/27/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND: Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects. METHODS: The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted. RESULTS: The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care. CONCLUSION: High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.
Collapse
|
10
|
Le Guen M, Beigelman C, Bouhemad B, Wenjïe Y, Marmion F, Rouby JJ. Chest computed tomography with multiplanar reformatted images for diagnosing traumatic bronchial rupture: a case report. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R94. [PMID: 17767714 PMCID: PMC2556736 DOI: 10.1186/cc6109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 07/24/2007] [Accepted: 09/03/2007] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Unnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity. METHODS Three-dimensional reconstruction of the airways using a workstation connected to a multidetector chest computed tomography (CT) scanner may change the diagnostic strategy in patients with blunt chest trauma with clinical signs evocative of bronchial rupture. RESULTS In this case report of a young motor biker, a complete disruption of the intermediary trunk was first misdiagnosed using standard chest helical CT and bronchoscopy. Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed. Follow-up using CT with three-dimensional reconstructions evidenced a bronchial stenosis located at the site of the rupture. CONCLUSION The present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.
Collapse
Affiliation(s)
- Morgan Le Guen
- Department of Anesthesiology and Critical Care Medicine, Surgical Intensive Care Unit Pierre Viars and the Trauma Center, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France
| | - Catherine Beigelman
- Department of Radiology, Surgical Intensive Care Unit Pierre Viars and the Trauma Center, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France
| | - Belaid Bouhemad
- Department of Anesthesiology and Critical Care Medicine, Surgical Intensive Care Unit Pierre Viars and the Trauma Center, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France
| | - Yang Wenjïe
- Department of Radiology, Surgical Intensive Care Unit Pierre Viars and the Trauma Center, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France
| | - Frederic Marmion
- Department of Anesthesiology and Critical Care Medicine, Surgical Intensive Care Unit Pierre Viars and the Trauma Center, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France
| | - Jean-Jacques Rouby
- Department of Anesthesiology and Critical Care Medicine, Surgical Intensive Care Unit Pierre Viars and the Trauma Center, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France
| |
Collapse
|
11
|
Gavelli G, Napoli G, Bertaccini P, Battista G, Fattori R. Imaging of Thoracic Injuries. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Lomoschitz FM, Eisenhuber E, Linnau KF, Peloschek P, Schoder M, Bankier AA. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms. Eur J Radiol 2003; 48:61-70. [PMID: 14511861 DOI: 10.1016/s0720-048x(03)00202-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In patients after chest trauma, imaging plays a key role for both, the primary diagnostic work-up, and the secondary assessment of potential treatment. Despite its well-known limitations, the anteroposterior chest radiograph remains the starting point of the imaging work-up. Adjunctive imaging with computed tomography, that recently is increasingly often performed on multidetector computed tomography units, adds essential information not readily available on the conventional radiograph. This allows better definition of trauma-associated thoracic injuries not only in acute traumatic aortic injury, but also in pulmonary, tracheobronchial, cardiac, diaphragmal, and thoracic skeletal injuries. This article reviews common radiographic findings in patients after chest trauma, shows typical imaging features resulting from thoracic injury, presents imaging algorithms, and recalls to the reader less common but clinically relevant entities encountered in patients after thoracic trauma.
Collapse
Affiliation(s)
- Fritz M Lomoschitz
- Department of Radiology, University of Vienna Medical School, AKH Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
13
|
Abstract
The introduction of CT imaging in the 1970s revolutionized all aspects of medical care, perhaps nowhere more so than in the evaluation of acutely injured patients. Just as single-slice helical scanning was a great advance over conventional CT, the capabilities of MSCT are proving to be dramatically superior to single-slice methods. Improved contrast bolus imaging, thinner slices, and isotropic voxels should enable the trauma radiologist to identify both major organ system disruption and subtle injuries more promptly. Multiplanar and three-dimensional reconstructions, a forte of MSCT, facilitate rapid communication of disease states with surgeons and others involved in the care of injured patients. In many centers, whole-body CT is beginning to supplant plain films of the chest and spine in the evaluation of severe trauma victims; the cost-effectiveness of such methods is still under evaluation.
Collapse
Affiliation(s)
- Luis A Rivas
- Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, West Wing 279, 1611 Northwest 12th Avenue, Miami, FL 33136, USA
| | | | | | | |
Collapse
|
14
|
Galanski M. Thoraxtrauma. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|