Tracheal injury

Background

• Usually occurs at junction of trachea and cricoid cartilage
• direct trauma to airway is rare due to protection by sternum and mandible
• Common causes:
  • Motor vehicle accident: extended neck impacts on steering wheel or dashboard
  • "clothes line injury", assaults/strangulation
  • Penetrating trauma (usually stabbings or gunshot wounds)
• Associated with cervical spine injury, head injury, multisystem trauma

Clinical Features

• Respiratory distress
• Hoarseness, dysphonia, cough, stridor, dysphagia
• Subcutaneous emphysema
• Cervical ecchymosis
• Hemoptysis
• Tracheal deviation or abnormal laryngeal contour

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

See Also

• Thoracic Trauma