Injuries to the tracheobronchial tree in closed trauma.

Seven cases of injury to the tracheobronchial tree in closed trauma of the thorax, treated by the surgical emergency service of the Hospital das Clínicas, University of São Paulo School of Medicine, during the period 1980-2 are described and compared with previously published cases. The diagnosis of the seven cases presented in this series was clinically suspected and endoscopically confirmed within 24 hours of injury, all patients being immediately submitted to reconstructive surgery; and except for one who failed to respond to initial resuscitation and died during surgery all the patients had a satisfactory postoperative course. Many previously reported cases of tracheobronchial injury by contrast have taken more than a month to be diagnosed; but for the best results such injuries must be repaired immediately. Awareness of the possibility of tracheobronchial injury in cases of violent chest trauma is important for early diagnosis; emphysema, dyspnoea, and pneumothorax are not always present, and absence of radiological and clinical signs of tracheobronchial injury does not exclude such injury. Bronchoscopy is the most important investigation for clinical diagnosis. Once the diagnosis has been made thoracotomy is nearly always required. Throughout the surgical procedure expert cooperation between anaesthetist and surgeon is essential. After operation prevention of further damage to the trachea depends on careful respiratory management.