Tracheal Perforation: Causes, Diagnosis & Treatment

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  • 0:04 Tracheal Perforation
  • 1:18 Diagnosis
  • 2:49 Treatment
  • 3:40 Prognosis & Complications
  • 4:44 Lesson Summary
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Lesson Transcript
Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Tracheal perforation occurs when there is an injury to the trachea and a disruption to the airway. This lesson will discuss the causes, diagnosis, and treatment of a tracheal perforation.

Tracheal Perforation

Troy was in the wrong place at the wrong time. He was in a convenience store shopping for bread when a robber came in. During the robbery the cashier fired a gun at the direction of the robber, but Troy somehow got grazed in the neck with the bullet. Police are on the scene and call for an ambulance to take Troy to the hospital. He has a hole in his trachea.

A tracheal perforation occurs when there is damage to the trachea. The trachea is also called the windpipe and is located in the throat. It starts at the larynx and proceeds down to the bronchial tubes to supply air to the lungs. Perforation to the trachea is not common, but is usually caused by:

  • Trauma (such as gunshot wounds, knife stabbings, car accident)
  • Infections
  • Sores caused by foreign objects

Anatomy of the airway including the trachea
Anatomy of the airway, including the trachea

It's clear that Troy's tracheal perforation is a direct result of the bullet that grazed his neck. He is in need of immediate assessment and treatment at a hospital. Troy is currently coughing up blood and having trouble breathing. During his transport the paramedics place a breathing tube to protect his airway and supply oxygen to his body and brain. The medical team recognizes all of Troy's symptoms, but other tracheal perforations require diagnostic tests.

Diagnosis

Diagnosing a tracheal perforation from an external injury is simple because the trauma can be seen. However, the trachea can be damaged from the inside. Symptoms of a tracheal perforation include coughing up blood, difficulty breathing, and bubbles of air that appear under the skin on the neck, arms, chest, or abdomen. These bubbles can be felt and are called subcutaneous emphysema.

Even when a tracheal perforation is external, radiographic tests are required to determine the location and severity of injury. These tests are also imperative to diagnose internal tracheal perforations. A chest x-ray is the first line of diagnostic tests that can determine injury to the trachea. It can show where the damage is and what else is being affected. A CT scan of the neck visualizes any interruption in the airway as well. It provides an in-depth image of damage to the trachea and surrounding structures. A bronchoscopy makes a definitive diagnosis of tracheal perforation. A scope is inserted through the mouth or nose and into the trachea to get an inside look at the damage.

Bronchoscopy done to assess damage to the trachea
Bronchoscopy done to assess damage to the trachea

The first test that Troy has is a bronchoscopy so the doctor can determine how much of the trachea is affected. The hole in Troy's trachea is small from the outside, but the doctor has to assess the damage that the bullet did to the inside of the trachea when it grazed the neck. Troy has already begun getting treatment with the breathing tube, but the doctors are now able to provide further treatment based on the results of the bronchoscopy.

Treatment

The first treatment for a tracheal perforation is to maintain the airway, usually by placing a breathing tube (intubation). The most common form of treatment for a tracheal perforation is surgery, especially when caused by trauma. Sutures and any type of reconstruction are done during the surgical procedure. Smaller tracheal perforations or ones that affect the small bronchi may be treated without surgery. Other interventions include a chest tube to correct a collapsed lung, antibiotics to treat an infection, and a bronchoscopy to remove any foreign objects from the airway.

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