Tracheobronchial Fracture




-Tracheal Fracture:
1) May occur in deceleration and thoracic crush injuries:

-Bronchial Fracture:
1) Often associated with fracture of the first 3 ribs
2) Usually occur in mainstem bronchi 1-2 cm distal to carina
3) Right mainstem bronchus is more commonly involved than the left mainstem bronchus
4) Pulmonary vessels are rarely injured
5) Displacement of bronchus may cause bronchial obstruction (and distal atelectasis/lung collapse)

1) Sudden crushing compression of air against a closed glottis and a shearing action of the vertebral column against the airways
2) Lateral widening of the thorax and lungs, leading to lateral traction exceeding the elasticity of the bronchus


CXR/Chest CT Pattern: 10% of cases have normal imaging studies
1) Pneumomediastinum: espeically in the absence of mechanical ventilation
2) Pneumothorax: especially one that is recurrent despite chest tube drainage
3) SQ Emphysema


1) SQ Emphysema:
2) Dyspnea:
3) Wheezing:
4) Bronchial Stricture/Stenosis: may be delayed for weeks-months after injury, due to formation of granulation tissue
-10% of cases have normal imaging at the time of injury and only present later with stricture/stenosis