RESUMO
La incidencia de roturas traqueobronquiales secundarias a un traumatismo torácico cerrado es baja, y la mayoría de estos pacientes no llegan con vida a los centros de atención hospitalaria. La presentación clínica es variable dependiendo de la localización de las lesiones, los daños asociados y si las estructuras peribronquiales permanecen íntegras. Para su diagnóstico temprano se debe tener un alto índice de sospecha clínica y una correcta interpretación de los hallazgos semiológicos y radiológicos, lo que permite su rápida y correcta resolución. La demora en el tratamiento aumenta tanto la mortalidad como las complicaciones tempranas y tardías.
The incidence of tracheobronchial ruptures secondary to blunt thoracic trauma is low and most affected patients do not arrive alive to hospitals. Clinical presentation varies with the location of lesions, associated injuries and whether the peribronchial structures remain intact. Early diagnosis requires a high index of clinical suspicion and a correct interpretation of semiologic and radiologic findings, which allows for a rapid and correct resolution. Delay in treatment increases the mortality as well as early and late complications.
Assuntos
Humanos , Feminino , Adolescente , Traumatismos Torácicos/complicações , Brônquios/lesões , Fratura Avulsão/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , Toracotomia/métodos , Radiografia Torácica , Tomografia Computadorizada por Raios X , Pulmão/diagnóstico por imagem , Enfisema MediastínicoRESUMO
The occurrences of pneumothorax and pneumomediastinum are rare, but considered to be potentially life-threatening conditions in patients undergoing functional endoscopic sinus surgery under general anesthesia. Tracheobronchial rupture may results in serious complications, such as pneumothorax and pneumomediastinum. It may occur accidentally by endotracheal tube when the patient's neck is flexed or extended. We report the case of a 48-year-old female patient who developed massive subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum seven hours after functional endoscopic sinus surgery under general anesthesia.
Assuntos
Feminino , Humanos , Anestesia Geral , Enfisema Mediastínico , Pescoço , Pneumoperitônio , Pneumotórax , Ruptura , Enfisema Subcutâneo , Manobra de ValsalvaRESUMO
Tracheobronchial rupture due to blunt chest trauma is an uncommon injury and the clinical presentations are variable. Recently, the incidence of tracheobronchial injuries has increased with the increase in traffic accidents and mechanization.The early diagnosis and primary repair of tracheobronchial rupture not only restores normal lung function, but also avoids the difficulties and complications associated with delayed diagnosis and repair.We report our clinical experience in anesthetic management of a patient with complete tracheal transection suffering from progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax.The literature regarding accidental tracheal injuries will be reviewed.
Assuntos
Humanos , Acidentes de Trânsito , Diagnóstico Tardio , Dispneia , Diagnóstico Precoce , Incidência , Pulmão , Pescoço , Ruptura , Estresse Psicológico , Enfisema Subcutâneo , Parede Torácica , TóraxRESUMO
A number of complications during the use of double-lumen endobronchial tubes are reported, specifically tracheobronchial rupture, a rare but serious complication. Risk factors associated with tracheobronchial rupture include inexperienced endoscopists, intubating stylets, multiple vigorous attempts at intubation, overdistension of the tracheal or bronchial cuff with high pressure, position change with an inflated cuff, and anatomical abnormality. We report 2 cases of tracheobronchial rupture which occurred during the use of double-lumen endobronchial tubes.