Early Diagnosis of Pediatric Laryngotracheal Rupture Following Minor Blunt Trauma

Abstract

Laryngotracheal rupture is a rare but life-threatening condition that most commonly occurs after trauma to the chest or neck. Mechanism of injury involves large amounts of force. Therefore, injury is rare with low-impact trauma. It is important to keep in mind that physical exam and symptoms on presentation do not necessarily correlate with the severity of the injury. Case Presentation: 14 year-old male who presented to the Emergency Department (ED) fast track area with neck discomfort after minor blunt trauma to the anterior aspect of neck, while running. Patient went home, developed throat pain, mild hemoptysis and hoarseness. Therefore, mother decided to bring him to the ED. On physical exam, patient was found with mild subcutaneous emphysema of the neck and upper chest. Neck for soft tissue and chest radiograph confirmed the clinical impression of suspected tracheal rupture in view of subcutaneous emphysema and pneumomediastinum. Patient was transferred for ENT evaluation were neck CT showed complete laryngotracheal rupture. Patient required surgical management for lesion repair. Conclusion: Emergency Physicians should have a high level of suspicion in the presence of neck minor trauma where there may be a possibility of laryngotracheal injury. The patient’s outcome depends to a great degree on early diagnosis.