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Tracheobronchial Tear Imaging

Practice Essentials

Chest radiography is the standard initial imaging modality for evaluation of most chest conditions, including possible tracheobronchial injury, but computed tomography is preferred if a tracheobronchial tear is suspected.
In appropriate circumstances, multiplanar or virtual endoscopic reconstructions from the CT scan data can be performed to clarify questionable findings.

Definitive diagnosis of a tracheobronchial tear is made by bronchoscopy or surgical exploration. If clinical or radiographic findings suggest airway injury, diagnostic bronchoscopy is recommended.

Tracheobronchial tears are rare injuries that are usually related to blunt trauma that involves a partial or complete laceration or puncture of the tracheal or bronchial wall. Most patients have associated rib fractures, which may be the cause of the laceration.

The animation below simulates images from a bronchoscopy.

Animated cine images from virtual bronchoscopy. The animation begins with a view of the carina and advances distally into the right main bronchus. An obstruction of the right main bronchus is consistent with a bronchial tear.

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The radiograph below reveals injury to the right mainstem bronchus.

Frontal chest radiograph from a 26-year-old man af

Frontal chest radiograph from a 26-year-old man after major trauma. This image shows complete opacification of the right hemithorax without air bronchograms, abrupt termination of the right mainstem bronchus, and multiple upper right rib fractures.

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Other images below display tracheobronchial tears.

10-mm axial computed tomography (CT) scan of the c

10-mm axial computed tomography (CT) scan of the chest with the lung window settings beginning at the level of the carina. This image demonstrates abrupt termination of the right main bronchus and complete opacification of the right hemithorax without air bronchograms.

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10-mm axial computed tomography (CT) scan of the c

10-mm axial computed tomography (CT) scan of the chest with the mediastinal window settings beginning at the level of the carina. This image shows multiple right rib fractures and a moderate-sized pleural effusion. There is mediastinal shift toward the side of injury. Fluid density is present in the right main bronchus, probably representing hemorrhage.

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Conventional radiography and CT scanning play important roles in the imaging of tracheobronchial tears. Although imaging findings can be highly suggestive in certain instances, radiography and CT scanning are often nonspecific for evaluating tracheobronchial tears.

For patient education Information, see the Procedures Center, as well as Bronchoscopy.

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