Moriwaki Yoshihiro, Sugiyama Mitsugi, Fujita Seiichiro, Toyoda Hiroshi, Kosuge Takayuki, Yamamoto Toshiro, Amano Shizuka, Matsuzaki Syoichi, Shimoyama Toru, Tahara Yoshio, Iwashita Masayuki, Fukuyama Hiroshi, Suzuki Noriyuki
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
J Trauma. 2006 Nov;61(5):1156-61. doi: 10.1097/01.ta.0000196761.35256.05.
Bronchoscopy has been the gold standard for diagnosing blunt laryngo-cervical-tracheal injury (BLCTI); however, BLCTI is often undetected. Ultrasonography (US) is an indispensable tool in the field of critical care and traumatology, but has not been considered useful for evaluation of the airway. The aim of this study was to determine the usefulness of US in the diagnosis of BLCTI.
To determine the detectability of BLCTI by US, we use a model of cylindrical plastic with a protruding mass made of paste. The model was placed in a water bath and US (3.5-MHz probe) was used to try to detect the mass.
We could detect the existence of the mass as a high echoic mass with strongly high echoic tail. We used four patients with BLCTIs whose sites of injury were confirmed by computed tomography (CT) and bronchoscopy. We evaluated the larynx and the cervical trachea as their outline of air in the cranial section near the sternal notch using a 3.5-MHz convex probe. The following US findings were compared with CT and bronchoscopic images as specific findings of BLCTI: discontinuity of the laryngo-cervical-tracheal wall and an abnormal mass protruding into the laryngo-cervical-tracheal lumen. Specific findings of BLCTI were detected in three of the four patients, whose sites of injury were the anterior or lateral side of the larynx or the cervical trachea. The site of injury of the remaining patient, where we detected no specific BLCTI findings, was the posterior wall of the larynx.
US is useful for the diagnosis of BLCTI because it is capable of presenting specific images showing BLCTI features such as discontinuity of the laryngo-cervical-tracheal wall and abnormal masses protruding into the lumen; not only as a single diagnostic tool but one tool with many uses.
支气管镜检查一直是诊断钝性喉-颈-气管损伤（BLCTI）的金标准；然而，BLCTI常常未被检测到。超声检查（US）是重症监护和创伤学领域不可或缺的工具，但一直未被认为对气道评估有用。本研究的目的是确定US在BLCTI诊断中的效用。
为了确定US对BLCTI的可检测性，我们使用了一个带有由糊状物制成的突出肿块的圆柱形塑料模型。将该模型置于水浴中，使用US（3.5兆赫探头）试图检测该肿块。
我们能够将肿块的存在检测为具有强烈高回声尾部的高回声肿块。我们对4例经计算机断层扫描（CT）和支气管镜检查证实损伤部位的BLCTI患者进行了研究。我们使用3.5兆赫凸阵探头在胸骨切迹附近的头侧断面将喉和颈段气管评估为其空气轮廓。将以下US检查结果与作为BLCTI特异性表现的CT和支气管镜图像进行比较：喉-颈-气管壁连续性中断和异常肿块突入喉-颈-气管腔内。4例患者中有3例检测到BLCTI的特异性表现，其损伤部位为喉或颈段气管的前侧或外侧。其余1例患者未检测到BLCTI特异性表现，其损伤部位为喉后壁。
US对BLCTI的诊断有用，因为它能够呈现显示BLCTI特征的特异性图像，如喉-颈-气管壁连续性中断和突入管腔内的异常肿块；它不仅是一种单一的诊断工具，而且是一种具有多种用途的工具。
