Case Report
A 15-year-old male arrived at the ER following a MVA as a restrained
backseat passenger. Upon initial evaluation, the patient’s only
complaint was chest pain with no symptoms of airway distress or voice
change. Examination revealed a spontaneously breathing patient with
stable vital signs and adequate oxygen saturation. Physical exam was
remarkable for subcutaneous emphysema, and an upper chest seatbelt
bruise (FIGURE 1 ). A Neck and Chest CT scan revealed a
suspected posterior longitudinal tracheal tear along the right posterior
wall with associated bilateral pneumothorax and
pneumomediastinum.(FIGURE 2A and 2B) Bedside flexible
bronchoscopy revealed a longitudinal through-and-through distal right
posterior tracheal tear at the membranous wall measuring 4.0 cm and
expansion upon dynamic inspiration (VIDEO CLIP 1 ). Esophageal
soft tissue herniation was visualized upon inspiration without evidence
of connection (VIDEO CLIP 1 ). The distal portion of the tear
was approximately 0.4 cm from the carina. A multidisciplinary decision
was made to manage the tracheal laceration conservatively without
fiberoptic endotracheal intubation due to patient’s stable condition.
Yet, pneumothorax was managed with bilateral chest tube placement. In
order to completely rule out esophageal perforation a swallow study was
recommended. Reevaluation was performed at one week and the patient had
resolved chest pain and subcutaneous emphysema. Bronchoscopy revealed
posterior membranous tracheal laceration healed by secondary intention
without evidence of granulation tissue or collapse of the lumen.
Revaluation at two months revealed an intact posterior tracheal wall
without granulation tissue or stenosis.