Tracheal/bronchial ruptureDefinition: This injury is a tear or break in the trachea (windpipe) or bronchial tubes, the major airways leading to the lungs. The injury may be caused by infections, ulcerations due to foreign objects, and trauma. A tear can also occur in the tracheal mucosa, the tissue lining of the windpipe.
Alternative Names: Torn tracheal mucosa
Causes, incidence, and risk factors: The trachea or bronchial tubes can be damaged by a penetrating wound like a gunshot, or a blunt trauma like an automobile accident, but these are uncommon. Injuries to the trachea or bronchi also may occur during medical procedures (e.g., fiberoptic bronchoscopy, placement of a breathing tube), but this is also very uncommon. Breathing a foreign body (e.g., food) into the trachea or bronchi may produce an infection and erosion through the wall, thus producing a disruption.
Symptoms: Trauma patients who develop a tracheal or bronchial rupture often have other injuries as well. Patients may have difficulty breathing, may cough up blood or other secretions, and may develop subcutaneous air (bubbles of air that can be felt underneath the skin of the chest, neck, arms, and trunk).
Signs and tests: - A chest X-ray may show collapse of the lung or evidence of infection.
- A chest CT scan may show similar findings.
- Fiberoptic bronchoscopy can show the exact extent and location of disruption of the trachea or bronchi.
Treatment: For trauma patients, other injuries will require simultaneous treatment. Injuries to the trachea often need to be repaired during surgery. Injuries to the smaller bronchi, especially if there is less than total disruption, can sometimes be treated without an operation. A collapsed lung is treated with a chest tube, connected to suction, that re-expands the lung. For patients who have breathed a foreign body into the airways, rigid or fiberoptic bronchoscopy may be used to retrieve the object. For patients with infection in the part of the lung surrounding the injury, antibiotics are used.
Expectations (prognosis): For trauma patients, the outlook depends on the extent of other injuries. Operations to repair these injuries often have good results. The outlook is good for patients with other causes of tracheal or bronchial disruption. In the months or years after the injury, scarring at the site of the injury may lead to problems that require additional diagnostic tests or procedures.
Complications: Major complications after operations for this injury include infection, prolonged need for the use of a ventilator, and scarring.
Calling your health care provider: Patients with major injuries to the chest, inhalation of foreign bodies, or signs and symptoms of chest infection should notify their physician.
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