Tracheobronchial Rupture due to Blunt Chest Trauma: Report of a Case

Abstract

Tracheobronchial injuries following blunt chest trauma are uncommon in children. The involvement of both the trachea and right main bronchus separately is highly unusual. We herein report the case of a 13-year-old boy who presented with both a tracheal and right main bronchial rupture following blunt chest trauma. While the tracheal laceration required a tracheotomy, a delayed repair of right main bronchial disruption was performed with a complete preservation of the right lung. The features of this uncommon entity are discussed, with special emphasis on early diagnosis and surgical management.

Tracheobronchial Rupture due to Compression Under a Cannon Barrel

“…Eighty percent of tracheobronchial rupture occurs within 2.5 cm of the carina, 15% involve the trachea, and 5% involve more distal airways [2,3]. The involvement of both the trachea and right main bronchus, as occurred in our case, is very rare.…”

“…The presence of pneumomediastinum, pneumothorax, or both may thus be suggested. The presence of bilateral pneumothoraces is more suggestive of tracheal lacerations and distal airway and/or parenchymal tears [2,3,7]. Computed tomography provides enhanced images of anatomical structures, in their retrospective study, Chen et al [8] found only 85% sensitivity for detecting tracheal rupture in fourteen patients with such an injury.…”

“…Surgery should be carried out as soon as a diagnosis is made and the patient's condition permits intervention. Primary repair is the gold standard for tracheobronchial injuries, and the key to successful treatment is airway management during surgery [2].…”

“…Early appropriate management can reduce the incidence of morbidity and death due to chronic bronchopleural fistula, empyema, and mediastinitis [2,3]. The case of a 16-year-old boy with both distal tracheal and right main bronchial ruptures following blunt chest trauma is herein reported, in which we emphasize the need for prompt diagnosis and appropriate management.…”

Tracheobronchial injury diagnosed by computed tomography scan: a case report

“…Less than 6% of these thoracic injuries involve the tracheobronchial tree, although the incidence could be higher owing to undocumented fatalities at the scene [1]. Because these injuries can immediately threaten life, occur infrequently, and are associated with diagnostic difficulty or delay in as many as 50%, surgeons must have a high index of suspicion and understand appropriate management [2]. Persistent pneumomediastinum, atelectasis, or air leak from a chest tube should prompt further investigation.…”