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.