Blunt bronchial injuries: A challenging issue

Natale, Claudia De; Lesquen, Henri de; Béranger, F.; Prunet, Bertrand; Bonnet, P; Avaro, J.-P.

doi:10.1016/j.injury.2014.01.006

Cited by 6 publications

(15 citation statements)

References 10 publications

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“…Furthermore, when there is complete transection of a main bronchus, atelectasis and an “absent hilum” can be seen [4]. In the scenario of a patient with pneumothorax secondary to blunt chest trauma, which does not improve despite tube thoracostomy, a bronchial rupture should be suspected [3, 5, 6]. The pneumothorax is caused by the communication of the bronchial lesion with the pleural space, while the pneumomediastinum and subcutaneous emphysema occur when there is a lack of communication between the lesion and pleural space.…”

Section: Discussionmentioning

confidence: 99%

“…The gold standard for the diagnosis and characterization of airway injuries is bronchoscopy, with evaluation of both the airway and digestive tract as appropriate, being the most effective tool to assess topography, extent, and depth of the lesion [2, 3, 5, 9, 10]. When the diagnosis is delayed, patients present with progressive dyspnea, stridor, and complete atelectasis of the distal lung [6], probably secondary to granulation tissue, which forms between 1 and 4 weeks after the event [4].…”

Section: Discussionmentioning

confidence: 99%

“…Tracheobronchial injury is one of the least common injuries in the scenario of blunt chest trauma. Nevertheless, it has a high mortality rate [1, 2]; tears or ruptures of the airway are seen in 0.5 to 1.5% of all cases [3, 4] and around 81% of patients with airway injury die immediately or before arriving at the emergency department due to tension pneumothorax [5, 6]. It presents with non-specific signs and symptoms challenging prompt diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Right main bronchus rupture associated with blunt chest trauma: a case report

et al. 2019

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BackgroundTracheobronchial injury is one of the least common injuries in the scenario of blunt chest trauma. However, around 81% of patients with airway injury die immediately or before arriving at the emergency department due to tension pneumothorax. It presents with non-specific signs and symptoms challenging prompt diagnosis.Case presentationA 15-year-old adolescent who was riding a bicycle suffered an accident when he fell down a cliff, approximately 5 m deep. Upon admission to the emergency department, he presented with signs of respiratory distress. The airway was secured and a thoracoabdominal angiography was performed. The image reported pneumomediastinum, a small right pneumothorax, areas of pulmonary contusion, and an image of loss of continuity in the anterior superior wall of the right main bronchus highly suggestive of bronchial rupture. The bronchial lesion was then confirmed by fiberoptic bronchoscopy. Taking into account the patient’s characteristics, conservative management was chosen, and the patient was transferred to the intensive care unit (ICU) where protective tracheal intubation was performed.ConclusionsA delay in diagnosis increases the rate of complications, mainly infectious complications and the formation of granulation tissue that could potentially obstruct the airway, impacting the patient’s outcome. The first step in the management of these patients is securing the airway, which should be done immediately. The gold standard for the diagnosis and characterization of airway injuries is bronchoscopy as it is the most effective tool to assess topography, extent, and depth of the lesion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Right main bronchus rupture associated with blunt chest trauma: a case report

et al. 2019

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“…Traumatic bronchial rupture in children is often caused by blunt chest trauma, which is rare in chest trauma. Because trauma in children is often combined with brain injury, abdominal organ injury, limb fracture and other complex injuries, the diagnosis of traumatic bronchial rupture in children is easily missed or delayed, resulting in different degrees of pulmonary infection and consolidation; in severe cases, lobectomy may be performed, or death may even result [1]. Early diagnosis and surgical treatment are beneficial to the prognosis of traumatic bronchial rupture in children.…”

Section: Introductionmentioning

confidence: 99%

Experience of diagnosis and treatment of traumatic bronchial rupture in children in a single clinical center

Wang

et al. 2020

Pediatr Surg Int

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Methods The diagnosis and treatment of eight cases of traumatic bronchial rupture were analyzed retrospectively from January 2014 to December 2019 in our hospital. Results Diagnosis of the eight patients was clear after a chest CT with three-dimensional reconstruction techniques and fiberoptic bronchoscopy; six of the patients had a delay in diagnosis of at least 2 weeks. Among the patients, six had left bronchus rupture, and the other two had right bronchus rupture. All eight patients received surgery; seven patients received a bronchial end-to-end valgus anastomosis, and one received right middle lobe lobectomy. There were no deaths in this group, and all patients were cured and discharged. Follow-up was conducted for 3 months to 2 years; the patients who received surgery showed mild bronchostenosis within 2 weeks after the trauma, and the other six patients showed moderate bronchostenosis upon CT examination. Conclusion Being alert to bronchial rupture after trauma in children is helpful for diagnosis. Chest CT with three-dimensional reconstruction techniques and fiberoptic bronchoscopy are the most valuable diagnostic methods. The patients can show excellent results if the operation for a continuous valgus anastomosis of the posterior wall and interrupted end-to-end valgus anastomosis of the anterior wall on the ruptured side is performed in the early stage of traumatic bronchial rupture.

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“…Cardiac and bronchial avulsions are very rare conditions in animals and humans. They are mainly related to blunt chest trauma [1][2][3][4]. Vehicle accidents are one of the main causes of death in dogs, with the thorax being the first region of injuries caused by this sort of trauma [5,6].…”

Section: Introductionmentioning

confidence: 99%

Complete cardiac and bronchial avulsion in a dog: Post-mortem computed tomography and forensic necropsy analysis

Pinto

Massad

Ribas

et al. 2017

Journal of Forensic Radiology and Imaging

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The aim of this case report was to describe non-contrast tomography findings of a cardiovascular trauma followed by a forensic necropsy in a dog. A female dog was struck by a vehicle, suffered a sudden death and was sent to a veterinary hospital. PMCT images were acquired on a 16-slice multidetector scanner and the forensic necropsy was performed afterwards. Thoracic images revealed aorta avulsion, heart dislocation, complete right bronchial rupture, pneumothorax, pleural effusion, subcutaneous emphysema, multiple rib and spine processes fractures, and a diaphragmatic rupture. Abdominal images showed free abdominal fluid, and laceration of the abdominal muscles leading to eventration of small bowel. Forensic necropsy findings corroborated the hypothesis of cardiac and bronchial avulsion. Even though no contrast media was administered in this case, it was possible to establish the cause of death based solely on the PMCT images. Further studies in this field should be conducted to evaluate the capabilities of PMCT in improving post-mortem diagnosis or even replacing it when necessary.

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Blunt bronchial injuries: A challenging issue

Cited by 6 publications

References 10 publications

Right main bronchus rupture associated with blunt chest trauma: a case report

Right main bronchus rupture associated with blunt chest trauma: a case report

Experience of diagnosis and treatment of traumatic bronchial rupture in children in a single clinical center

Complete cardiac and bronchial avulsion in a dog: Post-mortem computed tomography and forensic necropsy analysis

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