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

Abstract

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.

Management and outcome of bronchial trauma due to blunt versus penetrating injuries

“…Early diagnosis and treatment clearly decrease morbidity and mortality. Unfortunately, the diagnosis of BBT is often delayed until refractory atelectasis with pneumonia occurs, and many cases are diagnosed by FB only weeks after the injury[ 11 - 14 ]. In the BBT group of this series, 55.3% of patients were diagnosed more than 48 h after the injury.…”

“…Therefore, differential diagnosis is required when posttraumatic atelectasis exists. The most important diagnostic methods are 3D-spiral CT and FB, especially FB, which is recognized as the gold standard for diagnosis[ 14 , 15 , 17 - 19 ].…”

“…When accompanied by vascular injury, it should be repaired simultaneously. Many authors have indicated that pneumonectomy should be avoided if possible[ 7 , 10 , 14 , 20 ]. Pneumonectomy inevitably leads to pulmonary hypertension and right heart failure.…”

“…One patient in this group suffered such an outcome (Table 1 ). Debridement should be performed before anastomosis; otherwise, the rate of failure or complications, such as leakage and stenosis due to granulation, will increase[ 2 , 3 , 14 , 17 ]. If the lung can be expanded, anastomosis can be performed.…”

Case report: Incomplete laceration of the right middle lobar bronchus due to blunt chest trauma: An unusual pattern and attentions

“…The bronchial rupture in the chest cavity can lead to tension pneumothorax, subcutaneous emphysema as well as massive air leakage from the thoracostomy tube. However, if the ruptured bronchus does not communicate with the pleural cavity, the pneumothorax is not obvious and the main manifestation may be mediastinal emphysema ( 3 , 4 ). In our case, the diagnosis of bronchial injury was really difficult because the patient arrived in an emergency with multiple injuries.…”