TrachealDeviationCausesandTreatment

OverviewoftheTrachea
Thetracheaorwindpipeistheoneofthemostimportantstructuresusedinbreathing.[1]Itisatubeabout
1inchindiameterand46incheslong(inanormaladult),locatedverticallyinfrontoftheesophagus.Itisa
membranesupportedby1620cartilageringswhichpreventthetracheafromcollapsing.Theseringsare
openedontheback,beingconnectedbybandsofmuscles,whichinturnaidsthetracheatocontractand
expandwheneverwebreatheinandout.[2]

Tracheaalsoservesasalineofdefensewheneverweareexposedtocertainenvironmentalirritants.The
mucousmembranethatisliningitontheinsideisverysensitiveandstimulatesthecoughingreflextocough
upanyforeignbodythathasentered.

Figure1:Trachea
Credits:www.macmillan.org.uk
CausesofTrachealDeviation
Alotoffactorsmaycausethetracheatoshifttoeithersides.Trachealdeviationistheresultanteffect
whereinitshiftstotheareawherethereisarelativelyhighnegativepressure.
Asitisnormallysituatedverticallyonastraightmannerfromtheneckareadowntothechest,achange
onitsanatomicalorientationwillbeanareaofconcernespeciallyifitiscopresentedwithothermajor
symptoms.[3]
Inthisarticle,thedifferentcausesoftrachealdeviationwillbepresentedbutaspecialapproachwillbe
giventopneumothoraxsinceitissaidtobethemostlifethreateningconditionassociatedwithit.

Figure2:TrachealDeviation

Credits:www.tacmedsolutions.com
TrachealDeviationonInfants
Thisisaconditionofnoclinicalconcern.Theinfantsuptoageoffiveyearsoldtendtohavetracheal
deviationwhichisnotlinkedtoanymedicalconditions.Thisisduetotheirrelativelyshortneckcomparedto
thetracheawhichwillthenresolveonitsownandwillbeoutgrownafterwards.[4]
Atelectasis
Atelectasisisthemedicaltermusedforcollapsedlung.Thelungcollapsesduetoanobstructionorblockage
thatimpedesitsabilitytosufficientlyinflate.
PleuralFibrosis
Thisisthethickeningofthepleura(thelininginsidethechestcavity)thatcouldhaveresultedfromchronic
inflammationandresultstocalcification.
Pneumonectomy
Thisisaprocedurethatisdonetotreatlungcancer.Itisasurgicalremovalofthelung,partiallyor
completely.
PleuralEffusion
Aconditionwhereinthereisanaccumulationoffluidbetweenthechestwallandthelungs(alsocalled
pleuralspace).Thoughtrachealdeviationisasignificantfinding,itsmanifestationcanonlybeseenonce
thereisamassiveamountoffluidinvolved.
Tumors
Eitherbenignormalignant,itstillcancausetrachealdeviation.Alargemassfoundonthelung,bronchior
pleuralcavitycandisplacethetracheatotheside.[5]
Pneumothorax
Whenthereisaninjurytothelungs,pneumothoraxmayarise.Thelungsmaycollapseduetothelarge
volumeofairenteringthepleuralspace.Thisairwillthencompressandrestricttheexpansionofthelungs
duringinspiration,leadingtootherlifethreateningmanifestations.[6]
Duetothetracheasproximitytotheheart,thesignsandsymptomsthatmightbepresentalsohave
affectationtotheheartandtheorganssurroundingit.

Figure3:Pneumothorax
Credits:www.medicinenet.com
SignsandSymptoms
RespiratoryFindings
Respiratorydistressorrespiratoryarrest(consideredacardinalfinding)
Increaseinrespiratoryrate(tachypnea)
Asymmetryinlungexpansion
Absenceordecreaseofbreathsounds
Wheezesorcrackles(alsocalledasadventitiousbreathsounds)
Difficultyinbreathing(dyspnea)

CardiacFindings
Increaseincardiacrate(tachycardia)
Decreaseinbloodpressure(hypotension)
Distentionofthejugularvein(thoughthisoneisnotalwayspresentespeciallyifseverehypotensionis
present)[7]
Chestpain
OtherFindings
Management
NeedleThoracostomy

Agauge1416cannulathatistypicallyusedinintravenousinsertionwillbeintroducedonthesecond
intercostalspace.Itwillthenbeadvanceduntilaircanbeaspiratedtothesyringethatwillbeconnectedto

thecannula.Onceinplace,aguidingneedlewillberemovedtolettheairthatistrappedinsidetoescape.
Sincethisprocedureisdoneblindly,itisveryriskyandraisessomeconcernsandisevenlabeledthatit
resultstosomecomplications.
ChestDrainPlacement
Thisoneisthemostdefinitivetreatmentforpneumothoraxandissurgicallydone.Atubewillbeplacedon
thepleura,thesamemechanismthattheairwillbeallowedtoescape.Butthisoneissaidtobesafersince
thisisdonevisuallycomparedtotheneedlethoracostomy.[9]

Figure4:NeedleThoracostomy
Credits:www.johnsarm.net

Figure5:ChestTubePlacement
Credits:www.alfa.saddleback.edu
DetectionofTrachealDeviationandotherSignsandSymptoms
Deviationofthetracheacanbeeasilydetectedbygrosslyexaminingitoramerepalpationwilldo.Butifyou
wanttoascertainyourassessment,youwontneedanyhighenddiagnosticproceduresinceasimplexray
willdo.[10]
Therearealsocommonsignsandsymptomsthatcanbegenerallypresentaccompanyingtracheal

deviationsuchas:
Dyspnea(difficultybreathing)
Cough
Abnormalbreathsounds(asassessedbyadoctorusingastethoscopeorevenonlywiththebareearsif
itisaudibleenough)[11]
Treatment
Trachealdeviationisamanifestationratherthanaconditionthatiswhythetreatmentwillbefocusedon
correctingtheunderlyingproblemsforittobeaddressed.Justlikeinthemanagementofpneumothorax,
wherechesttubeinsertionorneedlethoracostomycanbeperformedtoremovethepressureinsidethe
pleuralspace.[13]
Overall,trachealdeviationshouldalwaysbetreatedwithgreatconcern.Apromptandeffectivemanagement
shouldbestartedandalwaysonhandsinceitimposesagreatriskwhichimposesalifethreateningstateor
evendeath.

References:
1.http://en.wikipedia.org/wiki/Trachea
2.http://www.merriamwebster.com/dictionary/trachea
3.http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/cxr/atlas/trachealshift.htm
4.http://resus.me/trachealdeviationininfants/
5.http://en.wikipedia.org/wiki/Tracheal_Deviation
6.http://www.healthhype.com/trachealdeviationcausesofatracheawindpipeshift.html
7.http://emedicine.medscape.com/article/424547clinical#a0256
8.http://emedicine.medscape.com/article/424547clinical
9.http://www.trauma.org/archive/thoracic/CHESTtension.html
10.http://respiratorytherapycave.blogspot.com/2011/06/trachealshiftcanhelpwithyou.html
11.http://www.reference.com/motif/health/whatcausestrachealdeviation
12.http://emedicine.medscape.com/article/424547differential
13.http://en.wikipedia.org/wiki/Tracheal_Deviation