CTICasesTraumatic Tracheal Perforation Post-Tracheostomy
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Imaging findings
A patient with a brain injury underwent tracheostomy placement and subsequently developed respiratory distress. Chest radiograph shows an armored tracheostomy tube, pneumomediastinum (with a V-sign of the clavicle), and subcutaneous emphysema. CT reveals the tracheostomy tube distorting the trachea, with the cuff inflated. A clear defect is visible in the posterior tracheal wall, communicating with extensive pneumomediastinum. There is also aspirated material in the lower lobes.
Key takeaways
Traumatic tracheal perforation is a severe complication of tracheostomy placement, typically involving the posterior membranous trachea. Imaging findings include pneumomediastinum, subcutaneous emphysema, and potentially difficulty with ventilation. CT clearly demonstrates the tracheal wall defect and its communication with surrounding air.
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