Pediatric tracheal injuries: Report on 5 cases with special view on the role of bronchoscopy and management
| Autor: | Tamás Kassai, Nikolett Gáti, András Vizi, Tamás Prokopp, Judit Réka Hetthéssy |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Thoracic Injuries medicine.medical_treatment Wounds Nonpenetrating 03 medical and health sciences 0302 clinical medicine Bronchoscopy medicine Humans Thoracotomy Pneumomediastinum Child Retrospective Studies General Environmental Science 030222 orthopedics medicine.diagnostic_test business.industry Infant Mediastinum 030208 emergency & critical care medicine respiratory system medicine.disease Tracheobronchial injury Tracheal Stenosis Surgery Trachea medicine.anatomical_structure Pneumothorax Child Preschool General Earth and Planetary Sciences Female business Pediatric trauma |
| Zdroj: | Injury. 52:S63-S66 |
| ISSN: | 0020-1383 |
| Popis: | Introduction The purpose of these case reports is to draw the attention to the difficulties of diagnosing trachea injuries in children, who are often part of a polytrauma scenario. Materials A retrospective multicenter analysis of 5 cases were analysed. The age of the children was between 1 and 16 years old. Injury mechanism was blunt thoracic trauma, misintubation and shot injury. Results Case No.1. a three-year-old child suffered a train accident. Resuscitation and decompression of the tension pneumothorax were performed. CT found a pneumomediastinum and bubbles along the trachea. Thoracolaparotomy was performed. Bronchoscopy could not rule out a tracheal injury. The child died of a cerebral edema. Case No. 2: a 13 month drowned and was resuscitated. A chest drain was inserted to treat the pneumothorax. CT revealed a pneumomediastinum, which was drained and a small tear of the trachea. Bronchoscopy was not preformed. Case No. 3: 9 year-old polytrauma patient was airlifted with bilateral mini thoracostomies and chest drains for pneumothorax. CT revealed bilateral pneumothorax and pneumomediastinum. The chest drains were repositioned oxygenation improved, but some ventilation difficulties remained. CT revealed pneumomediastinum and a tracheal injury. This was bridged by a tube, and the mediastinum drained. The ventilation difficulties were resolved. Case No. 4: an eight-year-old boy was shot on the neck. The region was explored surgically and the laceration of the trachea was sutured. Case No. 5: 12-year-old girl suffered blunt thoracic trauma. CT revealed bilateral pneumothorax and pneumomediastinum. Bilateral thoracic drainage was performed, some ventilation problems persisted. CT and fiberoscopy revealed a rupture of the trachea. Thoracotomy was performed and the laceration was closed. Conclusion Pneumomediastinum and persistent ventilation difficulties should raise suspicion of a tracheal injury in a typical clinical scenario. Bronchoscopy is recommended for early diagnosis, despite the possibility of misdiagnosis. In certain cases CT scan only and close observation may be considered. |
| Databáze: | OpenAIRE |
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