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

Abstract

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.

Use of a modified tracheal tube in a child with traumatic bronchial rupture: A case report and review of literature

“…Many reports have recommended that immediate primary repair is the preferred treatment for bronchial rupture[ 25 , 26 ]. Conservative management is only chosen for small lesions characterized by less than one third of the bronchial circumference, with easy ventilation, stable pneumomediastinum or subcutaneous emphysema, and the absence of respiratory distress and sepsis, which focuses on effective mechanical ventilation[ 3 , 9 , 12 , 15 , 27 ]. However, as early as 1971, Myers et al [ 28 ] proposed the idea of selective repair, that is, to defer repair until the local edema and inflammatory reaction have subsided.…”

Vỡ Phế Quản Chính Bên Trái Do Chấn Thương: Nhân Một Trường Hợp Điều Trị Thành Công - Nhìn Lại Y Văn

“…Trong đó hay gặp nhất là suy hô hấp (76 -100%) và tràn khí dưới da (87%) có hay không kèm tràn khí màng phổi (17 -70%) (một hay hai bên), dẫn lưu màng phổi không hiệu quả và khí thoát ra nhiều qua dẫn lưu. 1,6,8,9 Hơn nữa, đa số các bệnh nhân thường có những tổn thương phối hợp khác kèm theo (sọ não, bụng, cột sống…), khiến cho việc nhận định triệu chứng nhiều khi khó chính xác. 5 X-quang ngực là phương pháp thăm dò đơn giản và nhanh chóng: Ngoài các dấu hiệu gợi ý như tràn khí màng phổi, tràn khí dưới da, có thể thấy dấu hiệu "phổi rơi" -cần phân biệt với hình ảnh xẹp phổi thụ động do tình trạng tràn khí, có thể hình ảnh phế quản chính ngắt quãng ở rốn phổi trong trường hợp đứt lìa hoàn toàn.…”

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

“…The incidence of tracheobronchial injury is 2%-6% among patients with chest trauma[ 1 - 5 ]. Of these patients, approximately 80% die before they arrive at the hospital[ 5 - 9 ]. With the improvement of prehospital care, the number of patients who arrive at the hospital alive has increased[ 4 , 6 , 10 ]; thus, early diagnosis and treatment should be considered to improve their survival.…”