Tracheobronchial injury is a rare but potentially fatal complication of blunt chest trauma. Delays in diagnosis may occur because the signs are nonspecific and these injuries are infrequent. This case report describes a patient who experienced blunt chest injury with a resulting left main bronchus rupture that was not initially diagnosed. The most challenging aspect of reconstruction surgery for tracheobronchial rupture is to design an effective ventilation method during operation that does not interfere with surgical exposure and allows adequate ventilation. Communication with the surgical team and careful planning of all surgical details are important. We review our experience, the ventilation technique and anesthetic problem encountered in the patient undergoing bronchial reconstruction.
Bronchi* ; Diagnosis ; Humans ; Rupture* ; Thoracic Injuries ; Thorax* ; Ventilation

OBJECTIVETracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.

METHODSA retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.

RESULTSThe average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.

CONCLUSIONSTracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.

Adult ; Bronchi ; injuries ; Developing Countries ; Female ; Humans ; Male ; Retrospective Studies ; Trachea ; injuries

Adult ; Bronchi ; pathology ; Foreign Bodies ; etiology ; Humans ; Male ; Neck Injuries ; etiology ; Trachea ; injuries

Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented.
Humans ; Female ; Adult ; Pneumothorax/surgery* ; Bronchi/injuries* ; Wounds, Nonpenetrating/diagnosis* ; Bronchoscopy ; Trachea/injuries*

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.
Wounds, Nonpenetrating/*diagnosis ; Tomography, X-Ray Computed/*methods ; Time Factors ; Thoracic Injuries/*diagnosis ; Male ; Humans ; Constriction, Pathologic ; Child, Preschool ; Child ; Bronchial Neoplasms/*pathology ; Bronchi/*injuries/pathology ; Accidents, Traffic

Major fracture of the intrathoracic airway following ohest trauma is a potentially lethal injury which can be repaired sueceasfullr if the diagnosis is made early. Cough, dyspnea, cyanosis, hemoptyala, mediastinal emphysema or pneumathorax, and a Deterioration of the patient's Clinical condition out of proportion to the apparant closed chest injury should alert the clinician to the possibility of this entity. This report describes the patients who damitted to the intensive care unit for ventilator support and left main bronchus rupture was recognized after 21-trauma-way with the aid of bronchogram. Aeter then pneumonetomy was done and transferred to the general ward after weaing from the ventiltor support. from the above report it can he concluded that the bronchogram with the aid of fiberoptic bronchoscope is easentially necessary for the diagnosis of the major airwar injury.
Bronchi* ; Bronchoscopes ; Cough ; Cyanosis ; Diagnosis ; Dyspnea ; Humans ; Intensive Care Units ; Mediastinal Emphysema ; Patients' Rooms ; Rib Fractures* ; Ribs* ; Rupture* ; Thoracic Injuries ; Ventilators, Mechanical

OBJECTIVETo study the X-ray and CT findings of traumatic bronchial rupture for early radiographic diagnosis and treatment.

METHODSThe chest plain X-ray films and CT images of 21 patients with traumatic bronchial rupture confirmed by operations or bronchoscopy were retrospectively analyzed.

RESULTSThe main radiographic findings of traumatic bronchial rupture included interrupted tracheobronchial air column, atelectasis, lung ptosis, pneumomediastinum and subcutaneous emphysema, pneumothorax or hydropneumothorax. CT scanning also revealed tracheobronchial wall defect, bronchostenosis, and bronchial occlusion, displacement and angulation.

CONCLUSIONChest plain X-ray film combined with CT scanning has important values for early diagnosis of traumatic bronchial rupture.

Adolescent ; Adult ; Aged ; Bronchi ; injuries ; surgery ; Bronchoscopy ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Young Adult

Tracheobronchial injuries are uncommon. Except for the cervical region, most tracheobronchial injuries are due to blunt chest trauma in Korea. The depth of the tracheobronchial trees renders these structures relatively safe from stab wound. We experienced a case of left main bronchial laceration with azygos vein tear following stab wound in the back of right chest firstly in Korea. The patient was a 24 years old male. A routine chest radiography showed a knife in chest at emergency room. We didn't remove the knife at emergency room. This patient was carried to operation room in 30 minutes after arrival of our hospital without computed tomography and bronchoscopy. The operation was performed through standard right posterolateral thoracotomy and then the knife was removed. The left main bronchus and azyos vein were lacerated obliquely. The penetrated azygos vein was ligated and the laceration of the left main bronchus was repaired. Postoperative course was uneventful.
Azygos Vein* ; Bronchi* ; Bronchoscopy ; Emergency Service, Hospital ; Humans ; Korea ; Lacerations* ; Male ; Radiography ; Thoracotomy ; Thorax ; Veins ; Wounds and Injuries ; Wounds, Stab* ; Young Adult

The incidence of the bronchial rupture following blunt chest trauma has increased gradually with the increases of traffic accident and mechanization. We have experienced the 3 cases of the bronchial rupture following blunt chest trauma. The first case was a 38 year old man who was compressed into a blank wall by fork-lift. He complained of severe dyspnea with air leak through the chest tube and right pneumothorax with collapsed lung was seen in his chest X-ray film after closed thoracostomy. Emergency bronchoscopy showed disruptions of the right upper lobar bronchus and the membranous portion of the intermediate bronchus. The second was 8 year old boy who was sustained a crushing chest injury by bus. He also complained of severe dyspnea with air leak through the chest tube and right pneumothorax with collapsed lung was seen in his chest X-ray film after closed thoracostomy. We performed the computed tomogram of the chest and found the bronchial rupture at the distal portion of the right main bronchus. The third case was 40 year old male who was sustained a crushing chest injury by in-car accident. He complained of mild dyspnea without air leak through the chest tube and the left lung was well expanded in his chest X-ray film after closed thoracostomy. Bronchoscopy showed disruption of the 6th cartilaginous portion of the left main bronchus. Emergency bronchoplasties were performed with interrupted end-to-end anastomosis in all cases. Postoperative air leak occurred for 7 days in the third case. Others were uneventful.
Accidents, Traffic ; Adult ; Bronchi ; Bronchoscopy ; Chest Tubes ; Child ; Dyspnea ; Emergencies ; Humans ; Incidence ; Lung ; Male ; Pneumothorax ; Rupture* ; Thoracic Injuries ; Thoracostomy ; Thorax* ; X-Ray Film

Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may cause airway obstruction and resulting life-threatening respiratory deficiency. However, the clinical presentations are variable and frequently difficult to diagnose. We report a case of a previously healthy 16-year-old man with complete right main bronchial transection sustained after a vehicular accident, who had progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax. Prompt chest tube drainage for suspected bilateral tension pneumothorax and a tracheal intubation were performed. Shortly after the positive pressure ventilation, severe subcutaneous emphysema developed and he was at risk for developing shock. Additional chest tubes were inserted. An emergency bronchoscopy showed rupture of the right main bronchus. After changing to a double lumen endotracheal tube, the patient’s condition improved. A surgical closure was performed and postoperative bronchoscopy showed good repair. The patient was discharged without complications.
Adolescent ; Airway Obstruction ; Bronchi ; Bronchoscopy ; Chest Tubes ; Drainage ; Dyspnea ; Emergencies ; Humans ; Intubation ; Neck ; Pneumothorax ; Positive-Pressure Respiration ; Rupture* ; Shock ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracic Wall ; Thorax*