Using CT to Diagnose Tracheal Rupture
Jen-Dar Chen1,2,
Kathirkamanathan Shanmuganathan2,
Stuart E. Mirvis2,
Karen L. Killeen2 and
Richard P. Dutton3
1
Department of Radiology, Veterans General Hospital, Taipei and National
Yang-Ming Medical School, Taipei, Taiwan.
2
Department of Radiology and Shock Trauma Center, University of Maryland School
of Medicine, 22 S. Greene St., Baltimore, MD 21201.
3
Department of Anesthesiology and Shock Trauma Center, University of Maryland
School of Medicine, Baltimore, MD 21201.
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Fig. 1. —Icepick injury to trachea in 30-year-old man. CT scan at
thoracic inlet shows extensive paratracheal air (arrows).
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Fig. 2A. —Direct visualization of tracheal injury is possible in two
patients who sustained blunt force trauma. In 18-year-old man, CT scan
obtained at level of upper mediastinum shows defect (arrowhead) in
membranous trachea. Mediastinal emphysema (straight arrows) and left
lung contusion (curved arrow) can be seen.
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Fig. 2B. —Direct visualization of tracheal injury is possible in two
patients who sustained blunt force trauma. In 31-year-old woman, CT scan
obtained at level of bifurcation of trachea shows defect in membranous trachea
with air tracking into mediastinum (arrowhead). Mediastinal emphysema
(arrows) can also be seen.
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Fig. 3. —Focal deformity of tracheal wall in 35-year-old woman who
sustained blunt force trauma. CT scan shows deformity (straight
arrow) of wall of trachea. Endotracheal tube (arrowhead) is seen
outside wall of trachea. Note mediastinal emphysema (curved arrow) in
superior mediastinum.
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Fig. 4A. —Overdistended endotracheal tube balloon in 35-year-old woman
who underwent emergent endotracheal intubation. Lateral radiograph of cervical
spine obtained at admission shows extensive deep cervical emphysema, spherical
or ovoid shape of distended endotracheal tube balloon (straight
arrows), and dislodged tooth (curved arrow).
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Fig. 4B. —Overdistended endotracheal tube balloon in 35-year-old woman
who underwent emergent endotracheal intubation. CT scan obtained at thoracic
inlet shows overdistended endotracheal tube balloon (arrow) and
soft-tissue air. Bronchoscopy (not shown) revealed long longitudinal
laceration at membranous wall of trachea.
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Fig. 5. —Photograph of experimentally injured cadaveric trachea
(length of laceration, approximately 7 cm) shows overdistended endotracheal
tube balloon herniating through injury site.
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Fig. 6A. —Herniation of endotracheal tube balloon through injury sites
in anterolateral wall of trachea in 15-year-old boy who sustained gunshot
wound to neck. Supine chest radiograph (A) and CT scan (B) of
lower neck show herniation of endotracheal tube balloon (arrowheads)
through site of injury in anterolateral wall of trachea mimicking the
appearance of mickey-mouse head. Bullet can be seen in lower neck
(arrow, B) with soft-tissue emphysema.
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Fig. 6B. —Herniation of endotracheal tube balloon through injury sites
in anterolateral wall of trachea in 15-year-old boy who sustained gunshot
wound to neck. Supine chest radiograph (A) and CT scan (B) of
lower neck show herniation of endotracheal tube balloon (arrowheads)
through site of injury in anterolateral wall of trachea mimicking the
appearance of mickey-mouse head. Bullet can be seen in lower neck
(arrow, B) with soft-tissue emphysema.
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Fig. 7A. —Injury sites in anterolateral wall of trachea in adult
cadaver. Photograph (A) and CT scan (B) of experimentally
injured trachea show nearly identical appearance as herniated endotracheal
tube balloon (arrows, B) seen in patient with similar
injury.
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Fig. 7B. —Injury sites in anterolateral wall of trachea in adult
cadaver. Photograph (A) and CT scan (B) of experimentally
injured trachea show nearly identical appearance as herniated endotracheal
tube balloon (arrows, B) seen in patient with similar
injury.
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Fig. 8A. —Herniation of endotracheal tube through membranous tracheal
injury site in 14-year-old boy with gunshot wound to neck. Axial CT image of
lower neck region shows dumbbell-shaped endotracheal tube balloon
(arrow) as result of herniation through injury site.
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Fig. 8B. —Herniation of endotracheal tube through membranous tracheal
injury site in 14-year-old boy with gunshot wound to neck. Sagittal
reformation CT image shows posterior herniation of endotracheal tube balloon
(arrow) into prevertebral soft tissues.
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Fig. 9. —Photograph of trachea of adult cadaver with short
(approximately 1 cm) experimentally created laceration of membranous trachea.
Note herniation of endotracheal tube balloon.
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Copyright © 2001 by the American Roentgen Ray Society.
