Teaching Case

Traffic accident

61-year-old male patient involved in a high-speed deceleration traffic accident. This deceleration mechanism justified chest CT survey.

Tracheo-bronchial injuries are reported in 0.03% to 2.8% of blunt chest trauma. They occur in very severe trauma and are associated with a 85% mortality. Tracheo-bronchial lesions are most often located in the membraneous portion, mainly at its junction with the cartilages. In 80% of cases, they lie within 2.5 cm of the carina. Admission chest X--ray may demonstrate indirect features, such as tracheal shift, widened mediastinum, pneumomediastinum, pneumopericardium, (tension) pneumothorax persisting despite adequate chest tube drainage, or possibly hemothorax, as well as subcutaneous and muscular or cervical emphysema. Direct radiological signs are rarely present: interruption of the radiolucent lumen, sharp angulation and Kumpe’s “fallen lung” sign, which relates to disrupted lung hilar attachments, with subsequent fall of the lung in the most dependent part of the chest. Computed tomography identifies the same indirect signs of tracheo-bronchial lesions as plain films. CT rarely depicts the tracheo-bronchial injuries directly.