A case of cervical tracheal injury secondary to blunt trauma to the chest is reported. A 36-year-old male visited our hospital complaining of dyspnea and hemoptysis after having been run over on the back of the chest. Physical examination revealed no sign of trauma (wound nor subdermal hematoma) on the surface of the neck but there was subcutaneous emphysema in the cervical and thoracic area. A chest X-ray and computed tomography revealed pneumomediastinum, right pneumothorax, subcutaneous and deep neck emphysema and a fracture of the right clavicle. After post oral in tubation and the insertion of a thoracostomy tube, fiberoptic bronchoscopy was performed, which showed a disruption of the trachea just beneath the sternal notch.
The patient was immediately taken to an operation room. Complete tracheal transection at the level of sixth ring was revealed, and was subsequently reconstructed by means of end-to-end anastomosis. Bilateral recurrent nerves were also damaged, but they were not repaired. The postoperative course was uneventful. Tracheostomy was done on the 14th postoperative day and the patient, with a sealed tracheobutton, was discharged on the 47th day.
In this case, the mechanism of cervical tracheal disruption was thought to be compression between the manubrium of the sternum and the vertebral column and the dramatic increase in intraairway pressure because the glottis was closed when the chest was crushed.
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