title: [Urgent thoracotomy for injuries to the tracheobronchial tree due to blunt trauma--a seven cases report and a literature review of 32 cases in Japan].
abstract: Surgery for injuries to the tracheobronchial tree due to blunt trauma occurs over three periods: an emergency period requiring emergency room thoracotomy, an urgent period, and a late period. We observed seven cases in which thoracotomy (tracheobronchial plasty and pneumonectomy/lobectomy) was carried out during the urgent period. Thirty-two similar cases reported in Japan possessed features with the same patterns. It has been considered that lesions were frequently injured near the carina and that the bronchus would be injured symmetrically. However, both our experience and a literature review shows that only 59% of the cases (23/39) were injured near the carina and that 88% of bronchial injuries (14/16) occurred on the right side. This report also reviews the following clinical symptoms and roentogenological signs that contributed to the diagnosis: 1) dyspnea or respiratory distress, 2) subcutaneous and/or mediastinal emphysema, 3) fallen lung sign, and 4) upper rib fractures. Although a flexible bronchofiberscope was performed only in 24 cases (75%) out of the 32 reviewed patients and only 20 (83%) out of the 24 was diagnosed, the examination should be performed for all the patients even with minor or possible injury of the tracheobronchial tree. The results also suggested that an immediate and accurate diagnosis and subsequent emergency thoracotomy may improve the prognosis of the injury for patients during emergency period.
authors.affiliation: Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Endoh
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D001980:Bronchi / Q000293:injuries* / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery*