Application of ultrasonography for blunt laryngo-cervical-tracheal injury.
BACKGROUND
Bronchoscopy has been the gold standard for diagnosing blunt laryngo-cervical-tracheal injury (BLCTI); however, BLCTI is often undetected. Ultrasonography (US) is an indispensable tool in the field of critical care and traumatology, but has not been considered useful for evaluation of the airway. The aim of this study was to determine the usefulness of US in the diagnosis of BLCTI.


METHODS
To determine the detectability of BLCTI by US, we use a model of cylindrical plastic with a protruding mass made of paste. The model was placed in a water bath and US (3.5-MHz probe) was used to try to detect the mass.


RESULTS
We could detect the existence of the mass as a high echoic mass with strongly high echoic tail. We used four patients with BLCTIs whose sites of injury were confirmed by computed tomography (CT) and bronchoscopy. We evaluated the larynx and the cervical trachea as their outline of air in the cranial section near the sternal notch using a 3.5-MHz convex probe. The following US findings were compared with CT and bronchoscopic images as specific findings of BLCTI: discontinuity of the laryngo-cervical-tracheal wall and an abnormal mass protruding into the laryngo-cervical-tracheal lumen. Specific findings of BLCTI were detected in three of the four patients, whose sites of injury were the anterior or lateral side of the larynx or the cervical trachea. The site of injury of the remaining patient, where we detected no specific BLCTI findings, was the posterior wall of the larynx.


CONCLUSIONS
US is useful for the diagnosis of BLCTI because it is capable of presenting specific images showing BLCTI features such as discontinuity of the laryngo-cervical-tracheal wall and abnormal masses protruding into the lumen; not only as a single diagnostic tool but one tool with many uses.
Moriwaki
Yoshihiro
Y
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan. qqc3@urahp.yokohama-cu.ac.jp
Sugiyama
Mitsugi
M
Fujita
Seiichiro
S
Toyoda
Hiroshi
H
Kosuge
Takayuki
T
Yamamoto
Toshiro
T
Amano
Shizuka
S
Matsuzaki
Syoichi
S
Shimoyama
Toru
T
Tahara
Yoshio
Y
Iwashita
Masayuki
M
Fukuyama
Hiroshi
H
Suzuki
Noriyuki
N
D001999:Bronchoscopy; D006801:Humans; D007830:Larynx / Q000000981:diagnostic imaging / Q000293:injuries*; D008953:Models, Anatomic; D019838:Neck Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging / Q000293:injuries*; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000000981:diagnostic imaging*