Tracheal rupture caused by blunt chest trauma: radiological and clinical features

The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the rad iomorphologic and clinical key findings of all consecutive tracheal rupture s were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as w ell as a subcutaneous emphysema on conventional chest X-rays. In five patie nts, one major hint leading to the diagnosis was a cervical emphysema, disc overed on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectas is n = 5; lung contusion n = 4; lung laceration n = 2: hematothorax n = 2 a nd hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. I(ey findings were ail provided b y conventional chest,X-ray. Tracheal rupture is suspected in front of a pne umothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cerv ical spine and chest films. Routine thoracic CT could also demonstrate thes e findings but could not confirm the definite diagnosis of an tracheal rupt ure except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard.