Left Bronchial Disruption and Aortic Rupture after Blunt Chest Trauma

Abstract

A 25-year-old male who had been involved in a traffic accident presented with a neurological disorder, bilateral pneumothoraces, and pneumomediastinum. Bronchoscopy revealed a complex rupture of the left bronchial tract. MRI revealed a sinus valsalva aneurysm. The bronchial lesion was first repaired via left thoracotomy. 10 days later, the aorta was repaired via sternotomy. In cases of combined bronchial and aortic lesion, a concomitant repair is not mandatory, at least when the aortic lesion appears limited and shows no signs of dissection.

Isolated Complete Rupture of Left Main Bronchus after Blunt Chest Trauma

“…Computed tomography gives information about the lung, the great vessels, the heart and the diaphragm. As the causes of bronchial, aortic and esophagus rupture are similar, one may suggest that patients with traumatic bronchial injury routinely should undergo screening to exclude concomitant lesions of the aorta and esophagus, regardless of the presence or absence of specific symptomatology [9,10].…”

“…After blunt chest trauma early diagnosis of possible associated vascular, tracheobronchial and esophageal injuries should be performed because all these lesions may be caused by the same mechanism [9,10,17]. Computed tomography gives information about the lung, the great vessels, the heart and the diaphragm.…”

“…Bronchoscopy is the main diagnostic procedure to confirm a bronchial disruption and should be performed in all patients with severe thoracic trauma [1,4,7,8,10,13,15]. In the case of a complete rupture the bronchoscope should be used as a guide during intubation either with a double lumen tube or with a single tube [4,7,13,15].…”

“…The true incidence of tracheobronchial injury is hard to establish, as a long proportion (30 to 80%) will die before reaching the hospital [3]. Left-sided injuries occur less frequently compared to right-sided ones, probably due to the length of left mainstem bronchus [4][5][6][7][8][9][10][11][12][13] (Table 1).…”