Anterior chest wall disassociation: a pattern associated with serious underlying injury

[...]disruption of the tracheobronchial tree is rare with a reported incidence between 0.3 and 2 per cent.1 Although bronchoscopy remains the gold standard in diagnosis, CT scans can detect tracheobronchial injury, which most commonly occur within 2.5 cm of the carina in blunt thoracic trauma.1 After diagnosis, surgical management is indicated in almost all cases.1 In contrast, the estimated incidence of BCI in blunt chest trauma patients has been reported in up to 76 per cent of cases although it is difficult to accurately estimate the incidence because of debate over definition.2 Furthermore, the diagnosis is difficult to make as there is no gold standard test available. Underlying pulmonary contusions may limit the ability to accomplish early extubation as has been reported in rib fracture patients.4 Cardiac instability from BCI may preclude operative intervention in the first 48 hours or until cardiac function recovers.2 Finally, there may be more pressing injuries that need to be addressed first such as tracheobronchial injury or potentially even aortic injury that may ultimately determine treatment course.