Tracheal rupture

Answer 1

Definition

A tracheal or bronchial rupture is a tear or break in the windpipe (trachea) or bronchial tubes, the major airways leading to the lungs. A tear can also occur in the tissue lining the windpipe.

Alternative Names

Torn tracheal mucosa; Bronchial rupture

Causes, incidence, and risk factors

The injury may be caused by:

• Infections
• Sores (ulcerations) due to foreign objects
• Trauma, such as a gunshot wound or automobile accident

Injuries to the trachea or bronchi also may occur during medical procedures (for example, fiberoptic bronchoscopy and placement of a breathing tube). However, this is very uncommon.

Symptoms

Trauma patients who develop a tracheal or bronchial rupture often have other injuries. Patients may:

• Cough up blood
• Develop bubbles of air that can be felt underneath the skin of the chest, neck, arms, and trunk
• Have difficulty breathing

Signs and tests

• Chest CT scan
• Chest x-ray
• Fiberoptic bronchoscopy

Treatment

People who have had a trauma will need to have their injuries treated. Injuries to the trachea often need to be repaired during surgery. Injuries to the smaller bronchi can sometimes be treated without surgery. A collapsed lung is treated with a chest tube connected to suction, which re-expands the lung.

For patients who have breathed a foreign body into the airways, rigid or fiberoptic bronchoscopy may be used to take out the object.

Antibiotics are used in patients with an infection in the part of the lung around the injury.

Expectations (prognosis)

For trauma patients, the outlook depends on the severity of other injuries. Operations to repair these injuries often have good results. The outlook is good for people whose tracheal or bronchial disruption is due to other causes.

In the months or years after the injury, scarring at the injury site may cause problems that require other tests or procedures.

Complications

Major complications after surgery for this condition include:

• Infection
• Long-term need of a ventilator
• Narrowing of the airways
• Scarring

Calling your health care provider

Contact your health care provider if you have:

• Had a major injury to the chest
• Inhaled a foreign body
• Symptoms of a chest infection

References

Kraft M. Approach to the patient with respiratory disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 83.

Reviewed By

Review Date: 09/15/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.