Delayed Diagnosis of a Complete Bronchial Rupture after Blunt Thoracic Trauma

Abstract

Bronchial ruptures due to blunt chest traumas are rarely encountered injuries. They can be missed in the emergency room depending on the clinical findings. We present a case report of a previously healthy 32-year-old woman who received multiple rib and clavicula fractures on the right side in a traffic accident. The plain radiograms taken on the first and fifth day showed no other pathological findings than the above-mentioned fractures. Her control chest radiography, which was taken 7 weeks later, showed a totally opaque left hemithorax but no findings of pneumothorax were present. Fiberoptic bronchoscopy and virtual bronchoscopy showed a left main bronchial rupture. The patient was treated with an end-to-end anastomosis via left posterolateral thoracotomy.

Key words

Thoracic surgery - complete bronchial rupture - blunt thoracic trauma - virtual bronchoscopy

References

• 1 Velly J F, Martigne C, Moreau J M, Dubrez J, Kerdi S, Couraud L. Post traumatic tracheobronchial lesions. A follow-up study of 47 cases.  Eur J Cardiothorac Surg. 1991;  5 352-355
• 2 Kiser A C, O'Brien S M, Detterbeck F C. Blunt tracheobronchial injuries: treatment and outcomes.  Ann Thorac Surg. 2001;  71 2059-2065
• 3 Swan Jr K G, Swan B C, Swan K G. Decelerational thoracic injury.  J Trauma. 2001;  51 970-974
• 4 Huh J, Milliken J C, Chen J C. Management of tracheobronchial injuries following blunt and penetrating trauma.  Am Surg. 1997;  63 896-899
• 5 Wan Y L, Tsai K T, Yeow K M, Tan C F, Wong H F. CT findings of bronchial transection.  Am J Emerg Med. 1997;  15 176-177
• 6 Oto O, Acikel U, Silistreli E, Karabay O, Tuzun E, Gurgan U. et al . Traumatic main bronchial disruption: Radiologic evaluation and surgical management.  Asian Cardiovasc Thorac Ann. 1999;  7 68-70
• 7 Jardin M R, Remy J, Deschildre F, Artaud D, Ramon Ph, Edme J L. Obstructive lesions of the central airways: evaluation by using spiral CT with multiplanar and three-dimensional reformations.  Eur Radiol. 1996;  6 807-816
• 8 Graeber G M, Ganga Prabhakar, Shields T W. Blunt and penetrating injuries of the chest wall, pleura and lungs. Shields TW, Locicero J, Ponn RB, Rusch VW General Thoracic Surgery. 6th ed. Philadelphia, PA; Lippincott, Williams, and Wilkins 2005: 963-964