1/44. Isolated longitudinal rupture of the posterior tracheal wall following blunt neck trauma.The authors report 3 female children (4, 5 and 12 years old) who suffered an isolated rupture of the posterior tracheal wall (membranous part) following a minimal blunt trauma of the neck. Such tracheal ruptures often cause a mediastinal and a cutaneous thoraco-cervical emphysema, and can also be combined with a pneumothorax. The following diagnostic steps are necessary: X-ray and CT of the chest, tracheo-bronchoscopy and esophagoscopy. The most important examination is the tracheo-bronchoscopy to visualize especially the posterior wall of the trachea. Proper treatment of an isolated rupture of the posterior tracheal wall requires knowledge about the injury mechanisms. The decision concerning conservative treatment or a surgical intervention is discussed. In our 3 patients we chose the conservative approach for the following reasons: 1) The lesions of the posterior tracheal wall were relatively small (1 cm, 1.5 cm, 3 cm) and showed a good adaptation of the wound margins. 2) No cases showed an associated injury of the esophageal wall. All of our patients had an uneventful recovery, the lesion healed within 10 to 14 days, and follow-up showed no late complications.- - - - - - - - - - ranking = 1keywords = emphysema (Clic here for more details about this article) |
2/44. Surgical emphysema and pneumomediastinum in a child following minor blunt injury to the neck.Largyngotracheal and pharyngoesophageal tears following minor blunt trauma to the neck are uncommon. A child with such an injury is reported and the modes of diagnosis and management are discussed. patients may initially present with minimal signs and symptoms, but their condition may deteriorate rapidly or insidiously. In the absence of respiratory compromise, conservative management is appropriate, but all patients with significant blunt neck trauma should undergo early direct laryngoscopy under a general anaesthetic.- - - - - - - - - - ranking = 4keywords = emphysema (Clic here for more details about this article) |
3/44. Handlebar hernia with intra-abdominal extraluminal air presenting as a novel form of traumatic abdominal wall hernia: report of a case.An 18-year-old male was admitted to our Emergency Department with a traumatic abdominal wall hernia (TAWH) of the left lower quadrant (LLQ) after suffering hypogastric blunt injury and urogenital lacerations in a motorcycle accident. Upright chest X-ray showed a small amount of right infradiaphragmatic free air, and a computed tomographic (CT) scan demonstrated an abdominal wall hernia. At surgery, no impairment was found in the digestive tract, and an abdominal herniorrhaphy was performed. It is suggested that the free air had passed through a connection between the scrotal laceration and the contralateral abdominal defect via the subcutaneous space and was palpated as emphysema. This is a new type of TAWH, which suggests that blunt abdominal trauma may result in negative pressure in the subcutaneous and peritoneal cavity, and this could reflect the pathophysiology of TAWH.- - - - - - - - - - ranking = 1keywords = emphysema (Clic here for more details about this article) |
4/44. Traumatic pneumomediastinum caused by isolated blunt facial trauma: a case report.Traumatic pneumomediastinum is most often identified as an incidental finding in the setting of blunt or penetrating neck, chest, or abdominal trauma. There are only a few cases in the medical literature of a pneumomediastinum following isolated facial trauma. We present a patient who sustained fractures of the lateral and anterior walls of the right maxillary sinus, floor of the right orbit, and right zygomatic arch. subcutaneous emphysema overlaid the right facial region and extended to the left side of the neck and into the mediastinum. We describe this unusual complication with respect to the anatomic relations of the facial and cervical fascial planes and spaces with the mediastinum.- - - - - - - - - - ranking = 1keywords = emphysema (Clic here for more details about this article) |
5/44. Disruption in the intrathoracic trachea due to blunt trauma.Intrathoracic tracheal disruption by blunt trauma is rare and potentially life threatening. Here report 3 cases of intrathoracic tracheal disruption due to blunt trauma. Two cases, each 43 year old, involved an unrestrained male driver who suffered a head-on crash, while the other, 63 year old, involved a male who suffered compression. Chest roentgenograms on admission showed remarkable deep cervical and mediastinal emphysema in Cases 1 and 2 and mediastinal emphysema alone in Case 3. bronchoscopy revealed disruption in the trachea. Primary repair was performed through a right posterolateral thoracotomy in Cases 1 and 3 and through a median sternotomy in Case 2. In all cases the postoperative course was uneventful.- - - - - - - - - - ranking = 2keywords = emphysema (Clic here for more details about this article) |
6/44. Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the "fallen lung" sign.Tracheo-bronchial injuries occur in less than 1 % of blunt chest trauma patients. Indirect signs, such as pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, are revealed on admission plain films and chest CT survey. In most instances, however, tracheobronchoscopy is mandatory in assessing the definite diagnosis of tracheo-bronchial lesion. Occasionally, an abnormal course of a mainstem bronchus or a "fallen lung" sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury.- - - - - - - - - - ranking = 1keywords = emphysema (Clic here for more details about this article) |
7/44. An unusual case of surgical emphysema in the neck following sport injury.Surgical emphysema of the neck following sport injury without direct trauma to the neck is uncommon. We report a case of a flexion-hyperextension injury causing an air leak to the soft tissues of the neck. diagnosis, management and potential mechanisms are discussed. patients may initially present with minimal symptoms, but their condition may deteriorate rapidly or insidiously. In the absence of respiratory compromise, conservative management is appropriate.- - - - - - - - - - ranking = 5keywords = emphysema (Clic here for more details about this article) |
8/44. A diagnostic challenge: investigating suspected tracheobronchial and pharyngoesophageal tears. Are there gold standards?Pneumomediastinum and surgical emphysema of the neck as a result of blunt chest trauma occurs rarely. We report a case of pneumomediastinum and extensive surgical emphysema of the face and neck due to blunt chest trauma (assault), without evidence of laryngotracheal or pharyngoesophageal tear from the clinical assessment and the radiological examinations. diagnosis, management, evaluation of investigations and potential mechanisms are discussed. In the presence of suspicious tracheal rupture bronchoscopy is mandatory but not the gold standard to confirm the location of the tear, as seen in our case. In the absence of respiratory compromise, conservative management is appropriate.- - - - - - - - - - ranking = 2keywords = emphysema (Clic here for more details about this article) |
9/44. Tracheobronchial rupture due to blunt trauma in children: report of two cases.Tracheobronchial tree injuries occur in a small number of patients after blunt chest trauma, and their occurrence is uncommon in the pediatric trauma population. The authors report two male children, one with a tracheal rupture, and the other with disruption of the main right bronchus. Mediastinal and subcutaneous emphysema resulting in airway obstruction were noted in Case 1 and soft-tissue emphysema, pneumomediastinum and tension pneumothorax were evident in Case 2 at the time of presentation. In the child with bronchial disruption, a major airway injury was suspected early on, because of a massive air leak despite two properly placed chest tubes. The definitive diagnosis was established bronchoscopically, and thoracotomy and primary repair were performed. The child with rupture of the posterior tracheal wall was diagnosed at an early stage by bronchoscopy and he was successfully managed without surgery.- - - - - - - - - - ranking = 2keywords = emphysema (Clic here for more details about this article) |
10/44. Traumatic disruption of the cervical trachea.Treatment of a case of traumatic disruption of the cervical trachea has been described. This injury is not common but must be suspected in blunt chest trauma patients, with evidence of possible tracheal obstruction as in this patient. Massive subcutaneous emphysema, large air leaks, and persistent pneumothorax are more common signs of tracheobronchial disruption. diagnosis can be made with fiberoptic bronchoscopy, and primary repair is the treatment of choice.- - - - - - - - - - ranking = 1keywords = emphysema (Clic here for more details about this article) |
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