ABSTRACT
PURPOSE: To discuss the usefulness of CT scan in initial management of well tolerated tracheobronchial injuries and the place of tracheoscopy. METHODS: We report our experience of three cases treated for tracheobronchial rupture resulting from three different mechanisms and review the literature. Three boys, aged 4 to 10 years, were referred to our institution for tracheobronchial rupture. Two of them presented with subcutaneous emphysema after a minor trauma, the third was a polytrauma referred after a severe car crash and was already intubated. We emphasise the importance of an initial CT scan, as this allowed us twice to confirm the tracheal wound prior to tracheoscopy. We discuss the necessity of performing a tracheoscopy in the case of a well tolerated lesion, as this procedure clearly worsened the ventilatory state in one of our cases. Moreover, one of our cases illustrates the fact that even a minor trauma can lead to life-threatening respiratory distress. All the lesions observed in our study were linear and were managed by thoracic drainage; they were then closely monitored and required no further surgical procedure. CONCLUSION: Tracheobronchial rupture in children can result from minor cervical traumas and in such cases special attention must be paid to mild discomfort or subcutaneous emphysema on admission. Initial CT scan can be very helpful in visualising the level of the rupture and its consequences with respect to the pulmonary parenchyma. One can question the necessity for tracheoscopy in well tolerated lesion, as its results do not always improve the therapeutic outcome.
Subject(s)
Bronchi/injuries , Diagnostic Techniques, Respiratory System , Trachea/injuries , Wounds, Nonpenetrating/surgery , Bronchoscopy , Child , Child, Preschool , Drainage , Emergency Medical Services , Humans , Male , Rupture , Subcutaneous Emphysema/etiology , Tomography, X-Ray ComputedABSTRACT
Diagnostic angiography and super selective embolization of the internal maxillary artery were performed on 16 cases between 1990 and 1995. The patients (mean age, 49 years) were treated for severe posterior epistaxis, refractory to local haemostatic therapy (nasal packing alone for the most of them), hypertension was found to be the most frequent predisposing factor, 13 patients had their nose bleeding stopped. Among the 3 failures, were 2 cases of Osler-Weber-Rendu disease, which were subsequently significatively improved by this method. We conclude that angiography with super selective embolization is considered as a valuable diagnostic and therapeutic option in the management of patients with severe epistaxis.
