Delayed Diagnosis of Complete Tracheal Transection After Blunt Neck Trauma

The clinical features of tracheal injury include hoarseness, subcutaneous emphysema and edema, and bruising of the neck. Patients with tracheal injury may present with minimal signs that are easily overlooked. The priority in treating such patients is to appropriately identify the tracheal anatomy before further treatment is administered. In this case, a male patient aged 17 years was injured over the first tracheal ring while riding a motorcycle. His stable condition obscured pathognomonic signs of complete cervical tracheal transection, which caused an unnecessary delay in treatment. In a case such as ours, the application of high resolution computed tomography (CT), as an adjuvant to bronchoscopy is important. If tracheal transection is suspected, the proximal and distal ends of the trachea might be not on the same axis and traditional laryngoscopy should not be performed in haste. A CT virtual bronchoscopic evaluation can provide great accuracy when analyzing the central and segmental bronchi, and can prevent a delayed diagnosis of complete tracheal transection. If the diagnosis is still not definite, then diagnostic bronchoscopy and intubation at the operating room is recommended.