title: Application of ultrasonography for blunt laryngo-cervical-tracheal injury.
abstract: 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.
authors.affiliation: Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan. qqc3@urahp.yokohama-cu.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Moriwaki
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Fujita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Toyoda
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kosuge
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Shizuka
authors.initials: S
authors.lastname: Amano
authors.forename: Syoichi
authors.initials: S
authors.lastname: Matsuzaki
authors.forename: Toru
authors.initials: T
authors.lastname: Shimoyama
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tahara
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Suzuki
mesh_terms: 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*