Laszlo Scheinpflug (Magdeburg / DE), Thomas Schilling (Magdeburg / DE), Anita Dumitrescu (Magdeburg / DE), Anton Popov (Magdeburg / DE), Bastian Fakundiny (Magdeburg / DE), Thorsten Walles (Magdeburg / DE)
Abstract text (incl. references and figure legends)
Case history
A 10-year-old girl was involved as a passenger in the back of a car in an accident on the Autobahn and suffered a severe decelaration trauma.
Clinical findings
The patient was unresponsive upon arrival in the trauma room. Clinically, there was pronounced shortness of breath. Physical examination revealed soft tissue emphysema on the left chest wall and hyperresonant percussion on the left side of the chest.
Investigation/results
Computer-tomography of the chest showed multiple fractures of the cervical vertebrae (CV 2, 6 and 7) and a rupture of the trachea at the cervico-thoracic junction with complete dehiscence of the airways. Bronchoscopy confirmed complete transection of the trachea a few cm below the larynx. The tracheal ends were detached for several cm.
Diagnosis
Tension pneumothorax on left side and tracheal rupture.
Therapy and Progressions
The tension pneumothorax on the left side was relieved immediately through a puncture needle and then treated with a chest drain. The tracheal rupture was bridged using bronchoscopically guided intubation and the airways were secured. The cervical fractures were rated as stable and were treated conservatively. The airways were reconstructed surgically on the day of the accident by end-to-end anastomosis. An oesophageal injury was excluded intraoperatively. The patient was extubated on the 2nd postoperative day and the chest tube was removed the following day. Further clinical course was uneventful. Postoperatively, vocal cord function was intact on both sides.
Comments
Airway ruptures are rare and life-threatening injuries. Early surgical primary reconstruction secures the airways and prevents mediastinitis. By bundling the clinical competencies of various specialist areas at centers with maximum care, the care of children is also ensured.
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