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Chest computed tomography with multiplanar reformatted images for diagnosing traumatic bronchial rupture: a case report.

Le Guen M, Beigelman C, Bouhemad B, Wenjïe Y, Marmion F, Rouby JJ - Crit Care (2007)

Bottom Line: Unnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity.Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed.The present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France. morgan.le-guen@psl.aphp.fr

ABSTRACT

Introduction: Unnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity.

Methods: Three-dimensional reconstruction of the airways using a workstation connected to a multidetector chest computed tomography (CT) scanner may change the diagnostic strategy in patients with blunt chest trauma with clinical signs evocative of bronchial rupture.

Results: In this case report of a young motor biker, a complete disruption of the intermediary trunk was first misdiagnosed using standard chest helical CT and bronchoscopy. Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed. Follow-up using CT with three-dimensional reconstructions evidenced a bronchial stenosis located at the site of the rupture.

Conclusion: The present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.

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Related in: MedlinePlus

Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower pulmonary vein (white arrow). (d) Coronal view demonstrating multiple areas of alveolar consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).
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Figure 2: Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower pulmonary vein (white arrow). (d) Coronal view demonstrating multiple areas of alveolar consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).

Mentions: The patient was then transported to the Department of Radiology for a total body scan (16 slices; Lightspeed GE, General Electric, Milwaukee, WI, United States of America)). The following injuries were diagnosed: brain damage, related to a left parietal contusion with mild subarachnoid hemorrhage (Fisher II); and bilateral pneumothorax with a small hemothorax predominating on the left side, pneumomediastinum, pulmonary interstitial emphysema (Macklin effect [19]), pneumopericardium, subcutaneous emphysema and multiple rib fractures (Figure 2). It has to be pointed out that the right-upper-lobe bronchus was displaced posteriorly without a characteristic CT fallen sign as described by Tack and colleagues [18]. Other concomitant injuries were: myocardial contusion, diagnosed as the presence of sinus tachycardia with an anterior and septal elevation of the ST-segment on EKG (electrocardiogram) and an initial cardiac troponin I value of 10.25 IU (normal value, <0.04 IU); fracture of the first thoracic vertebra without neurological consequence; and right femoral fracture. Orthopedic surgical repair was performed without delay.


Chest computed tomography with multiplanar reformatted images for diagnosing traumatic bronchial rupture: a case report.

Le Guen M, Beigelman C, Bouhemad B, Wenjïe Y, Marmion F, Rouby JJ - Crit Care (2007)

Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower pulmonary vein (white arrow). (d) Coronal view demonstrating multiple areas of alveolar consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2556736&req=5

Figure 2: Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower pulmonary vein (white arrow). (d) Coronal view demonstrating multiple areas of alveolar consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).
Mentions: The patient was then transported to the Department of Radiology for a total body scan (16 slices; Lightspeed GE, General Electric, Milwaukee, WI, United States of America)). The following injuries were diagnosed: brain damage, related to a left parietal contusion with mild subarachnoid hemorrhage (Fisher II); and bilateral pneumothorax with a small hemothorax predominating on the left side, pneumomediastinum, pulmonary interstitial emphysema (Macklin effect [19]), pneumopericardium, subcutaneous emphysema and multiple rib fractures (Figure 2). It has to be pointed out that the right-upper-lobe bronchus was displaced posteriorly without a characteristic CT fallen sign as described by Tack and colleagues [18]. Other concomitant injuries were: myocardial contusion, diagnosed as the presence of sinus tachycardia with an anterior and septal elevation of the ST-segment on EKG (electrocardiogram) and an initial cardiac troponin I value of 10.25 IU (normal value, <0.04 IU); fracture of the first thoracic vertebra without neurological consequence; and right femoral fracture. Orthopedic surgical repair was performed without delay.

Bottom Line: Unnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity.Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed.The present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France. morgan.le-guen@psl.aphp.fr

ABSTRACT

Introduction: Unnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity.

Methods: Three-dimensional reconstruction of the airways using a workstation connected to a multidetector chest computed tomography (CT) scanner may change the diagnostic strategy in patients with blunt chest trauma with clinical signs evocative of bronchial rupture.

Results: In this case report of a young motor biker, a complete disruption of the intermediary trunk was first misdiagnosed using standard chest helical CT and bronchoscopy. Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed. Follow-up using CT with three-dimensional reconstructions evidenced a bronchial stenosis located at the site of the rupture.

Conclusion: The present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.

Show MeSH
Related in: MedlinePlus