Retrosternal tracheal pain

Specialty: Respiratory.

• painful tracheitis
• tracheal burning
• retrosternal tracheobronchial pain

Why it occurs

• Acute bacterial or viral tracheitis (inflammation of the mucosa of the trachea, commonly secondary to infections by influenza virus, respiratory syncytial virus or Staphylococcus aureus, which causes a burning sensation located behind the sternum that worsens drastically when coughing or breathing in cold air)
• Inhalation of irritating gases or corrosive chemical vapors (such as chlorine, ammonia or fire fumes, which cause chemical burns and peeling of the tracheal mucosa)
• Prolonged or traumatic endotracheal intubation (edema, ischemia or ulceration of the tracheal wall induced by excessive pressure of the pneumatic cuff)
• Aspiration of a sharp or irritating foreign body in the trachea
• Tracheomalacia or severe dynamic tracheal collapse with friction of mucosal walls.

Initial workup

Nasofibroscopy and flexible bronchoscopy (to directly evaluate the state of the tracheal mucosa, presence of ulcers, pseudomembranes or stenosis); X-ray of the neck (lateral projection to evaluate retrotracheal space) and chest; Computed tomography (CT) of the neck and chest with multiplanar reconstruction; Culture of tracheal secretions obtained by direct aspiration.

Standard management

• Paracetamol — 500-1000 mg orally or intravenously every 6-8 hours for pain and fever control
• Dexamethasone — 4 mg intravenously or orally every 12 hours to reduce the inflammatory component and tracheal mucosal edema
• Ceftriaxone (1-2 g intravenously every 24 hours if secondary bacterial tracheitis is suspected or confirmed).