Johannes Gossner (Krankenhaus Oststadt- Heidehaus/Klinikum Hannover)  

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8 Years  

Female  

Thorax-Trachea  

other  

8 year old girl s/p fall with the neck on the bath tub and developed subsequently dyspnea. After arrival of the EMS team, dyspnea became so severe that the girl had to be intubated. During the course, the girl developed a progressive soft tissue emphysema (with deflated endotracheal tube).  

N/A  

<- view CT 1

CT 1: Axial neck CT in lung window: There is an extensive soft tissue emphysema, which extends from the neck to mediastinum and into the chest wall.




<- view CT 2

CT 2: Coronal reconstruction of a neck CT in lung window:
Coronal reconstructed images demonstrate an extensive soft tissue emphysema, which extends from the neck to mediastinum and into the chest wall.





<- view CT 3

CT 3: Magnified view of an axial neck CT in lung window:
Visible defect in the pars membranacea (arrow). Endotracheal tube is in place with extensive air in the soft tissues.



 

Imaging including endoscopy  

N/A  

Tracheal laceration is in general rare and only occurs in approximately 1% of cases with blunt thoracic trauma, because the trachea is an anatomically well protected structure. Problematic is the often delayed diagnosis because of subtle and unspecific findings and also because in case of polytrauma the attention to other more obvious inhjuries (1,2). Computed tomography allows a detailed depiction of air collections and often of the tracheal defect, as in this case. Chen et al. could show the defect in 70% of cases (3). This is especially helpful in therapeutic planning, because in a clinically stable patient with small lacerations, a conservative approcach still leads to good results (1,2). In a review of the literature 15 cases were reported by Claes et al.: all children survived a small tracheal rupture after blunt trauma and only in one patient hoarseness persisted (2).  

N/A  

N/A  

1. Medline:
Kühne CA, Kaiser GM, Kühl H, Fischer M, Nast-Kolb D, Paffrath
Trachealeinriss nach stumpfem Halstrauma beim Kind
Chirurg (2003); 74: 579-582

2. Medline:
Claes I, Van Schil P, Corthous B, Jorens GP
Posterior tracheal wall laceration after blunt neck trauma in children: a case report and review of the literature
Resuscitation (2004); 63: 97-102

3. Medline:
Chen JD, Shanmuganathan K, Mirvis SE, Killeen KL, Dutton RP
Using CT to diagnose tracheal rupture
AJR 2001; 176: 1273-1280

 

Trauma, Trachea, Laceration, Computed tomography, child, childhood, pediatric radiology  

Johannes Gossner. Traumatic tracheal laceration. PedRad [serial online] vol 9, no. 2.
URL: www.PedRad.info/?search=20090225131032