Fiberoptic Bronchoscopy in the Evaluation of Acute Chest and Upper Airway Trauma: Discussion
Despite the frequent recommendation for bronchoscopy in the short-term evaluation of trauma, there are very few data on its sensitivity or the spectrum of findings encountered. Snow and Lucas reported on 67 bronchoscopic examinations performed on 51 patients in a surgical intensive care unit. The primary diagnosis was blunt trauma to the chest in seven patients and trauma to the airway in three patients. The primary indication for bronchoscopy was suspicion of trauma to the airway in eight patients (12 percent). The specific findings in these patients with trauma were not described. natural breast enlargement cream
Bronchoscopy has proven itself to be useful in the evaluation of injury to the airways. Ecker et al reported the findings in 24 patients admitted with traumatic tracheal or bronchial injuries. Thirteen patients had immediate bronchoscopy, and in each instance the diagnosis was either established or confirmed. Grover et al described 14 patients treated with major tracheal or bronchial injury. Bronchoscopy was diagnostic in all six patients in which it was performed. Kelly et al reported the findings in 24 consecutive patients with combined injuries of the trachea and esophagus. Twenty-one injuries were due to penetrating gunshot or stab wounds, and three were due to blunt trauma to the chest. All patients had undergone bronchoscopy. In only one patient did bronchoscopy fail to identify the lesion. The patient had sustained a gunshot wound and died because of a missed cervical tracheal injury. Jones et al described 13 patients with tracheobronchial disruption from blunt trauma to the chest due to motor vehicle accidents. Bronchoscopy was diagnostic in six (86 percent) of seven patients. One patient injured in a motor vehicle accident was found to have an 80 percent concentric stenosis of the right main-stem bronchus on the 29th day after injury, following previous normal findings on bronchoscopic examinations at days 1, 2, 3, and 6. Roxburgh reported the findings in eight patients with tracheobronchial injury in whom bronchoscopy was performed immediately. In three patients the injury was overlooked. Two of these patients had significant hemorrhage which impaired the examination. Our series revealed eight patients with tracheobronchial injury. In one patient an injury to the cervical trachea was identified but not fully appreciated to represent a complete transection. In no other patient was there any evidence that FFB failed to identify an injury to the airway or any other significant abnormalities. Because of the possibility that a lesion can be overlooked by bronchoscopy, repeat bronchoscopic examination should be performed if the clinical situation suggests that a lesion is present.