Multiplanar reconstruction: a new method for the diagnosis of tracheobronchial rupture?
OBJECTIVE
To compare multiplanar reconstruction with operative techniques (bronchoscopy, surgery and/or autopsy) for the diagnosis of tracheobronchial rupture.


METHODS
Prospective, observational study.


METHODS
Surgical intensive care unit.


METHODS
Tracheobronchial rupture was suspected on clinical grounds and from radiological findings.


METHODS
An initial helical computed tomography scan was performed on all patients meeting the inclusion criteria, and operative techniques were then performed. Multiplanar reconstructions were reformatted and reviewed by two independent radiologists.


RESULTS
Twenty-four consecutive patients met the inclusion criteria. Tracheobronchial rupture was diagnosed in 13 patients by at least one operative technique. Multiplanar reconstructions were positive in 15 patients. The diagnostic sensitivity and specificity of multiplanar reconstructions were 100% (95%CI, 85-100) and 82% (95%CI, 64-82), respectively. The positive and negative predictive values were 87% (95%CI, 74-87) and 100% (95%CI, 78-100), respectively. For tracheobronchial rupture, the positive and negative likelihood ratios were 5.5 (95%CI, 2.35-5.5) and 0 (95%CI, 0-0.24), respectively. The Kappa coefficients were 0.83 (95%CI, 0.6-1.06) for agreement between operative techniques and multiplanar reconstruction, and 0.91 (95%CI, 0.59-0.91) for agreement between the two radiologists.


CONCLUSIONS
Multiplanar reconstruction appears to be a sensitive technique for the identification of tracheobronchial rupture because of its excellent negative likelihood ratio. In clinical practice, negative multiplanar reconstruction can exclude a diagnosis of tracheobronchial rupture, making bronchoscopy unnecessary. When multiplanar reconstruction is positive, tracheobronchial rupture should be confirmed by bronchoscopy.


BACKGROUND
Trauma.
Hôpital Edouard Herriot, Département d'Anesthésie-réanimation, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France.
Alexandre
A
Faure
Bernard
B
Floccard
Frank
F
Pilleul
Frédéric
F
Faure
Bruno
B
Badinand
Nicolas
N
Mennesson
Thierry
T
Ould
Christian
C
Guillaume
Albrice
A
Levrat
Farida
F
Benatir
Bernard
B
Allaouchiche
D000328:Adult; D000368:Aged; D001980:Bronchi / Q000293:injuries*; D001999:Bronchoscopy; D005260:Female; D005602:France; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012421:Rupture / Q000175:diagnosis; D036542:Tomography, Spiral Computed / Q000379:methods*; D014132:Trachea / Q000293:injuries*