Traumatic Airway Injuries: Role of Imaging.

Authors:
Dr. Barun Bagga, MD
Dr. Barun Bagga, MD
All India Institute of Medical Sciences
Senior resident
New Delhi , Delhi | India
Atin Kumar
Atin Kumar
All India Institute of Medical Sciences
India
Anurag Chahal
Anurag Chahal
University of Texas Southwestern Medical Centre
Dallas | United States
Shivanand Gamanagatti
Shivanand Gamanagatti
All India Institute of Medical Sciences
New Delhi | India
Subodh Kumar
Subodh Kumar
Texas Tech University Health Sciences Center
Postdoctoral research associate
Alzheimer's disease
LUBBOCK, TX | United States

Curr Probl Diagn Radiol 2018 Oct 29. Epub 2018 Oct 29.

Department of Radiology and Department of Surgery, JPN Apex trauma Center, All India Institute of Medical Sciences, New Delhi, India.

Airway Injuries are rare but often immediately life threatening. Incidence ranges from 0.5-2 % in blunt and 1-6 % in penetrating trauma. Upper airway injuries (UAI) are often clinically apparent and get shunted during the primary survey in the emergency department. Few UAI and majority of lower airway injuries (LAI) are occult on primary survey and need a high suspicion index. Clinically, the diagnosis of tracheobronchial injury is delayed in many patients because the airway column is maintained by the peribronchial tissue. Imaging in the form of MDCT, in conjunction with endoscopy, plays a role in delineating the exact site and extent of injury and ruling out associated vascular and esophageal injuries for definitive management of UAI. Chest radiographs and ultrasonography help raise suspicion of LAI by detection of pneumomediastinum, persistent pneumothorax and/or subcutaneous emphysema and should be followed up with multidetector computed tomography (MDCT) which is the mainstay of diagnosis. However, it requires careful evaluation of the airway tract and a thorough knowledge about the mechanism of trauma for detection of subtle injuries. Reconstructions in multiple planes and use of various post-processing techniques including minimum intensity projection (MinIP) images enhance the detection rate. The specific signs of LAI on CT include discontinuity in the tracheobronchial tree, focal intimal flap projecting in the lumen, focal soft tissue attached to the tracheal/bronchial wall, complete cut off of the bronchus/trachea and the fallen lung sign. We, hereby, illustrate the imaging spectrum of traumatic airway injuries in detail and discuss their management implications.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S03630188183019
Publisher Site
http://dx.doi.org/10.1067/j.cpradiol.2018.10.005DOI Listing
October 2018
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