What are the other Names for this Condition? (Also known as/Synonyms)

• Bronchial Rupture
• Tracheobronchial Tear
• Windpipe Rupture

What is Tracheal Rupture? (Definition/Background Information)

• A Tracheal Rupture is a rare life-threatening condition wherein there is a tear or break in the trachea, or in one of the main bronchi (that branch off when the trachea splits), or in the tissue lining these tubes, which weakens the tube and leads to its rupture
• The trachea is a tubular structure of the respiratory system that connects the larynx to the lungs via the bronchus. It is also known as the windpipe and is the main airway that leads to the lungs. Tracheal Rupture is usually diagnosed in older adults
• The condition may be caused by infections, inhalation of foreign objects, injury to the windpipe, or following certain medical procedures, such as intubation or bronchoscopy, resulting in a Tracheal Rupture (iatrogenic factors)
• The signs and symptoms of the condition may include breathing difficulties, coughing-up of blood, and subcutaneous emphysema. Tracheal Rupture is a serious condition causing airways stricture and pneumothorax (lung collapse)
• Often, Tracheal Ruptures are treated as medical emergencies; the treatment may involve both conservative and invasive measures. The prognosis of the condition depends on several factors, but is generally good with prompt diagnosis and early treatment

Who gets Tracheal Rupture? (Age and Sex Distribution)

• Tracheal Rupture can occur in any individual irrespective of age, gender, ethnicity, or race
• Despite this, it is more prevalent in women and in individuals over 50 years of age

What are the Risk Factors for Tracheal Rupture? (Predisposing Factors)

The following are some risk factors associated with Tracheal Rupture:

• Respiratory infections
• Presence of foreign objects in the windpipe
• Post bronchoscopy or intubation
• Weakened airways

It is important to note that having a risk factor does not mean that one will get the condition.  A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors.  Some risk factors are more important than others.  

Also, not having a risk factor does not mean that an individual will not get the condition.  It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tracheal Rupture? (Etiology)

The possible causes for Tracheal Rupture include:

• Progression of an infection
• Sores or ulcers caused by foreign objects
• Trauma:
  • Gunshot wounds or similar penetrating injuries
  • Automobile accidents or other blunt trauma
• Torn tracheal mucosa causing rupture, due to other factors
• Iatrogenic causes: In rare cases, Tracheal Rupture can be caused during certain medical procedures
  • Intubation, or the insertion of a breathing tube (for a ventilator)
  • Medical procedures, such as fiber optic bronchoscopy, or the insertion of a tube with a camera down the trachea, in order to visualize it; the procedure may be termed flexible or rigid (flexible is much more commonly performed)
  • Hyperinflation of the bronchoscope cuff

One of the most important cause of Tracheal Rupture is complication during a bronchoscopy procedure, where a scope is inserted to examine the airways. Sometimes, too much air pressure within the bronchoscope, or the use of a large bronchoscope in smaller airways, or insertion of a scope in airways with weakened walls can result in Tracheal Rupture. This is called as Post-Intubation Tracheal Rupture.

It is believed that hyperinflation of the bronchoscope cuff (to allow an easier passage of the scope, and as result causing the scope to be larger than airway size), can cause damage to the airway walls. Sometimes, in addition to larger scope size, sudden change in position of the head with the inserted scope, also increases the risk for an injury or a tear. Such a rupture often presents as a linear tear in the lining tissue of the airways, when examined by the camera attached to bronchoscope.

What are the Signs and Symptoms of Tracheal Rupture?

Some common signs and symptoms of Tracheal Rupture include:

• Coughing up blood (hemoptysis)
• Subcutaneous emphysema: Development of palpable bubbles of air underneath the skin of the chest, neck, arms and trunk
• Breathing difficulty, especially while breathing in (inspiring)

How is Tracheal Rupture Diagnosed?

Tracheal Rupture is typically diagnosed using any of the following tests and exams:

• Thorough medical history and careful physical examination
• Special attention is paid to the presenting signs and symptoms, in order to maximize effectiveness of the tests

Commencing other tests, due to the urgent nature of the condition is advised, which include:

• Imaging tests such as:
  • Chest X-ray
  • Neck CT scan with possible chest CT scan
  • Fiber optic flexible bronchoscopy
• Other investigative procedures, as recommended by the healthcare provider

Many clinical conditions can have similar signs and symptoms.  Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Tracheal Rupture?

The complications from Tracheal Rupture can include:

• Infections
• Long-term need for a ventilator
• Airway narrowing
• Scarring at the injury site
• Rarely, if the rupture is lower in one of the bronchi, it may lead to pneumothorax (air in the cavity around one of the lungs, causing it to collapse)
• Complications that arise from intubation or bronchoscopy procedure causing airways wall injury

Complications may occur with or without treatment, and due to treatment also.

How is Tracheal Rupture Treated?

Tracheal Rupture is a medical emergency and requires to be promptly recognized and treated. The specific method of treatment depends on the exact nature of the injury.

• When Tracheal Rupture is caused by trauma, the underlying injuries must be treated, and often may require surgery
• Tears in the trachea are usually treated with the help of surgery; however, some can be managed conservatively, especially in smaller divisions of airways lower in the respiratory tree (mouth/trachea all the way down to the smallest units of the lungs), especially if no foreign object is stuck or otherwise involved
• A collapsed lung is typically treated by placing a chest tube over any physical injury or defect in the chest and applying suction; this allows the lung to re-expand
• Fiber optic bronchoscopy is usually employed when affected individuals have breathed-in foreign objects
• Antibiotics are prescribed for any infection that develops in the part of the lung surrounding the injury

How can Tracheal Rupture be Prevented?

There are no specific methods to prevent Tracheal Rupture. However, the following may be considered:

• Undertaking early treatment of any chest infections, ulcers, or injuries
• Ensuring proper medical standards while performing a bronchoscopy or any intubation
• Avoid letting children play with small toys/toy-parts (that may be ingested by them), in the absence of any constant adult supervision
• Stay away from construction sites, or other places with heavy debris particulates that could be inhaled

What is the Prognosis of Tracheal Rupture? (Outcomes/Resolutions)

The prognosis of Tracheal Rupture generally depends on the underlying causes but is usually good.

• When trauma is the cause, the outlook also depends on the severity of other accompanying injuries sustained and how well they are treated; however, procedures to correct such coexisting conditions generally yield good results
• When Tracheal Rupture is caused by other factors, such as presence of a foreign object, the outlook is generally good with prompt management
• Following the injury, scarring at the injury site may take place, which may create some other complications such as narrowing of the airways that must be quickly addressed

Additional and Relevant Useful Information for Tracheal Rupture:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/healthy-lungs/