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      Lesões da traquéia e grandes brônquios Translated title: Tracheal and major bronchial injuries

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          Abstract

          As lesões traqueobrônquicas são raras, porém, no trauma de tórax, envolvem grande risco de vida. As suas manifestações são variáveis e não é incomum o diagnóstico ser protraído. O sucesso no diagnóstico e tratamento, freqüentemente, requer alto grau de suspeição e a correção cirúrgica como método de escolha. Após trauma fechado de tórax, a ruptura da traquéia e dos brônquios principais, geralmente, ocorre nas proximidades da carina. O rompimento da árvore traqueobrônquica, ocasionado por acidentes em alta velocidade, com alto impacto e grande liberação de energia, geralmente está associado a outras lesões. Os sinais comumente presentes são: enfisema subcutâneo, dispnéia e hemoptise. Os achados radiológicos mais comuns incluem pneumotórax, pneumomediastino, fraturas de costelas e clavícula. As broncoscopias efetivamente rígida e flexível são considerados métodos diagnósticos eficazes, desde que manuseados por cirurgião torácico treinado. O diagnóstico precoce deve ser enfatizado, pois evita as complicações associadas ao reparo tardio das lesões. O mecanismo etiológico, o diagnóstico e os aspectos da terapêutica na literatura mundial são revistos e discutidos.

          Translated abstract

          Tracheobronchial injuries are rare but potentially life threatening. Their manifestations are variable and protean and misdiagnoses are common. Successful diagnosis and treatment often require a high level of suspection and unique surgical repairs to a given injury. Tracheal and main bronchial disruptions usually occurs after blunt chest trauma in the vicinity of the carina. Tracheobronchial disruptions occurred associated with high-energy impact trauma, and associated injuries were more common than they were to occur alone. Common presenting signs included subcutaneous emphysema, dyspnea, sternal tenderness, and hemoptysis. The most common were radiographic findings pneumothorax, pneumomediastinum, and clavicle or rib fractures. Rigid bronchoscopy and fiberoptic bronchoscopy were both highly accurate for the diagnosis but only when performed by trained thoracic surgeons. Emphasis has been placed on the importance of early diagnosis, to avoid the complications associated with a delayed repair. The etiological mechanisms, diagnostic and therapeutic aspects are reviewed and discussed.

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          Most cited references 30

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          Rupture of the tracheobronchial tree.

           J Roxburgh (1987)
          Eleven cases of tracheobronchial rupture are described. Nine were the result of external non-penetrating trauma and all but three had other serious injuries. The remaining two were caused by endobronchial intubation. Of the cases caused by external injury, respiratory tract injury was confined to the cervical trachea in three. Two required tracheostomy and repair and the third was managed conservatively; all made satisfactory recoveries. Intrathoracic rupture was recognised on or soon after admission in three cases. One patient died of uncontrollable pulmonary haemorrhage before he could be operated on; immediate repair gave good long term results in the other two. In three cases rupture of the main bronchus was not recognised until complete obstruction developed three, five, and 12 weeks after the accidents. The strictures were resected and the lung re-expanded. Robertshaw endobronchial tubes ruptured the left main bronchus in two patients undergoing oesophageal surgery. Uneventful recovery followed immediate repair. The difficulty of confirming rupture of a major airway is discussed and the importance of conserving the lung when the diagnosis has been missed is emphasised.
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            Management of Major Tracheobronchial Injuries: A 28-Year Experience

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              Traumatic injury of the cervicothoracic trachea and major bronchi.

               R B Lee (1997)
              Interstate highways and crowded urban areas have become the "battlefields" of the 1990s. The weapons are motor vehicles, handguns, and knives. This article relates the historical perspective, diagnosis, and management of traumatic injury to the cervicothoracic trachea and major bronchi. The etiologic factors are explained in depth. Examples of the current management of cervicothoracic tracheal injuries, including resection, primary repair, and the use of autogenous tissue to buttress or wrap the repair, are explained and illustrated.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Rev. Col. Bras. Cir.
                Colégio Brasileiro de Cirurgiões (Rio de Janeiro )
                1809-4546
                June 2000
                : 27
                : 3
                : 197-204
                Affiliations
                [1 ] Hospital Geral do Andaraí
                [2 ] Universidade Federal do Rio de Janeiro Brazil
                [3 ] Hospital Geral do Andaraí
                [4 ] Universidade Federal do Rio de Janeiro Brazil
                [5 ] Universidade Federal do Rio de Janeiro Brazil
                [6 ] Hospital da Força Aérea do Galeão
                [7 ] Universidade Federal do Rio de Janeiro Brazil
                [8 ] Universidade Federal de Juiz de Fora Brazil
                Article
                S0100-69912000000300010
                10.1590/S0100-69912000000300010
                Product
                Product Information: website
                Categories
                SURGERY

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