ABSTRACT
Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may cause airway obstruction and resulting life-threatening respiratory deficiency. However, the clinical presentations are variable and frequently difficult to diagnose. We report a case of a previously healthy 16-year-old man with complete right main bronchial transection sustained after a vehicular accident, who had progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax. Prompt chest tube drainage for suspected bilateral tension pneumothorax and a tracheal intubation were performed. Shortly after the positive pressure ventilation, severe subcutaneous emphysema developed and he was at risk for developing shock. Additional chest tubes were inserted. An emergency bronchoscopy showed rupture of the right main bronchus. After changing to a double lumen endotracheal tube, the patient’s condition improved. A surgical closure was performed and postoperative bronchoscopy showed good repair. The patient was discharged without complications.
Subject(s)
Adolescent , Humans , Airway Obstruction , Bronchi , Bronchoscopy , Chest Tubes , Drainage , Dyspnea , Emergencies , Intubation , Neck , Pneumothorax , Positive-Pressure Respiration , Rupture , Shock , Subcutaneous Emphysema , Thoracic Injuries , Thoracic Wall , ThoraxABSTRACT
Tracheobronchial injury (TBI) may lead to catastrophe if remains undetected or managed improperly. The incidence of TBI is less in children as compared with adults due to their pliable chest wall. Its clinical manifestations include persistent pneumothorax, cervical subcutaneous emphysema, pneumomediastinum, cyanosis, and respiratory insufficiency. The recommended airway management is to intubate the healthy bronchus with a single‑lumen or double‑lumen endotracheal tube (ET) and bypassing the injured side. We report successful anesthetic management of traumatic rupture of the left main bronchus in a child by using a single‑lumen cuffed‑ET. Many factors affect the outcome of such injuries and include the extent of the lesion, the resulting pulmonary status, the adequacy of surgical reconstruction. More severe injury may require lobectomy or pneumonectomy. Early diagnosis and proper management result in good functional outcome.
Subject(s)
Accidents, Traffic , Adolescent , Anesthesia/methods , Bronchi/injuries , Bronchi/surgery , Bronchoscopy/methods , Humans , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Lung/diagnostic imaging , Lung/surgery , Male , Pneumonectomy/methods , Rupture , Tomography, X-Ray Computed/methods , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/surgeryABSTRACT
Bronchial injury due to blunt trauma is often associated with other significant injuries; as a result, making a rapid diagnosis can be difficult. Delay of early diagnosis and surgical treatment can result in a fatal course, including persistent pneumothorax, soft tissue emphysema, lung collapse, recurrent infection, or death. Bronchoscopy remains a reliable diagnostic method; however, it is difficult to perform in the emergency department. In some cases, suspicion of emergency physicians, depending on findings observed on computed tomography scan, can be more helpful than bronchoscopy. In this article, we present two cases of bronchial injury after blunt chest trauma; differences in prognosis were dependent on the time taken to make a decision.
Subject(s)
Bronchoscopy , Early Diagnosis , Emergencies , Emphysema , Pneumothorax , Prognosis , Pulmonary Atelectasis , Rupture , ThoraxABSTRACT
Lung separation using a double-lumen endobronchial tube is necessary for video assisted thoracoscopy (VATs). Bronchial rupture after intubation with a double-lumen endobronchial tube has been rarely reported. We report a case of a 70-year-old man who had solitary pulmonary nodule in his right upper lobe. He was intubated with a left-sided Robertshaw double-lumen endobronchial tube. He underwent a VATs right upper lobectomy with the one-lung ventilation of left lung. During the operation, the rupture of the left mainstem bronchus was detected. Immediately, the thoracotomy was performed and the ruptured left mainstem bronchus was repaired with absorbable sutures (vicryl). Seven days later he had a bronchoscopy to examine the left mainstem bronchus. There was no evidence of the bleeding, leakage and inflammation. Subsequent course was uneventful. Tracheobronchial injuries related to the double-lumen endobronchial tube are discussed.
Subject(s)
Aged , Humans , Bronchi , Bronchoscopy , Hemorrhage , Inflammation , Intubation , Lung , One-Lung Ventilation , Rupture , Solitary Pulmonary Nodule , Sutures , Thoracic Surgery, Video-Assisted , Thoracoscopy , ThoracotomyABSTRACT
Rupture of the major airway by blunt chest trauma is uncommon. It can potentially cause serious complications, such as tension pneumothorax or cardiovascular injuries, with an overall mortality rate reaching up to 30%. The etiology of trauma includes fall-down, traffic accidents, cycling and child abuse. Dyspnea was the most common feature, followed by hemoptysis, air leak and chest pain. It is well known that dyspnea after chest trauma is due to accumulation of secretions in the airway, mucosal and cartilaginous injuries and associated parenchymal injuries. In cases of recurrent dyspnea in children irrespective of trauma, we should consider asthma, foreign body aspiration, tracheal stenosis, bronchial tumor, mediastinal tumor, gastroesophageal reflux disease and vascular ring. In this case, we found granulation tissue repeatedly causing obstruction of the airway at the site of rupture after traffic accident. Dyspnea resolved after surgical resection of the granulation tissue. We report a case of recurrent granulation tissue showing dyspnea after bronchial rupture.
Subject(s)
Child , Humans , Accidents, Traffic , Asthma , Chest Pain , Child Abuse , Dyspnea , Foreign Bodies , Gastroesophageal Reflux , Granulation Tissue , Hemoptysis , Pneumothorax , Rupture , Thorax , Tracheal StenosisABSTRACT
From January 2002 to November 2003 in the Cardiovascular and Thoracic surgical department of Cho Ray hospital, 12 cases of bronchial rupture were operated. The causes of trauma were trafic accidents or working accidents. Male: 10 cases, female: 2 cases. Indications of thoracotomy were: persistence of massive pneumothorax, ineffective drainage, atelectasis, confirmation of bronchial lesions from flexible bronchoscopy before operation 10 cases, 2 other cases performed during operation (with different thoracotomy indications: massive hemopneumothorax: 1 case, large open thoracic wound because of falling: 1 case). Procedure: direct suture of bronchial rupture: 9 cases, main bronchus repair: 1 case, lobectomy: 2 cases. Complications were respiratory failure: 3 cases, pneumonia: 1 case. Death: 2 cases due to respiratory failure, pneumonia, empyema, septicemia
Subject(s)
Rupture , Emergencies , Therapeutics , Bronchial Diseases , Wounds and InjuriesABSTRACT
Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.
ABSTRACT
Rupture of the bronchus following endotracheal intubation with a double-lumen tube is extremely rare in all complications of endotracheal intubation. We experienced a case of left main bronchial rupture following endotracheal intubation. This 58-year old female patient was diagnosed of well-differentiated adenocarcinoma of right lower lobe, stage II B, preoperatively. She was intubated with Robertshaw double-lumen tube (35 Fr.) for Rt. lower lobectomy. Intraoperatively, Lt. main bronchial rupture was suspected because of pneumomediastinum and ventilation insufficiency and immediately repaired with monofilament absorbable sutures (PDS) through left thoracotomy. Postoperative course was uneventful.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Bronchi , Intubation , Intubation, Intratracheal , Mediastinal Emphysema , Rupture , Sutures , Thoracotomy , VentilationABSTRACT
Recently, The non-penetrating injury of bronchus has been increased, especially by traffic accident. Early diagnosis and primary repair of bronchial injury not only restore normal lung function but also avoid the difficulties and complications associated with delayed diagnosis and repair. This report describes about a case of total collapse and consolidation of left lung with the complete transection of nearly bifurcated portion of left main bronchus , lasted for 2weeks after traffic accident. This was diagnosed by fiberbronchoscopy and 3-D chest computed tomography (CT). She underwent the sleeve resection and end to end anastomosis, and postoperative PEEP for 2 days, suctioning twice by fiberbronchoscopy, continue postural drainge and physiotherapy were applied. She had almost full expansion of the left lung at discharge.
Subject(s)
Accidents, Traffic , Bronchi , Delayed Diagnosis , Early Diagnosis , Lung , Suction , ThoraxABSTRACT
Traumatic rupture of the major airways may be caused by blunt or penetrating injury. The incidence of blunt trauma has risen dramatically in this century with the increase in modern high-velocity transportation. Clinical presentation of bronchial injuries in blunt trauma is varied, and the initial diagnostic evaluation is often misleading. The emphasis in management of these injuries is on early diagnosis and intervention. We experienced a case of bronchial rupture caused by blunt trauma. A 5-year-old male visited Emergency Room complaining of severe dyspnea and chest pain after traffic accident. Chest X-ray showed left tension pneumothorax. After emergent closed-thoracostomy, persistent air leakage and collapse of the left lung were noted. Chest CT revealed cut-off of left main bronchus and "dropped lung". Bronchoscopic examination confirmed the rupture of left main bronchus including proximal part of upper lobe bronchus. The patient underwent left upper lobectomy and bronchoplasty by using interrupted 4-0 Vicryl sutures. The postoperative course was uneventful.
Subject(s)
Child, Preschool , Humans , Male , Accidents, Traffic , Bronchi , Chest Pain , Dyspnea , Early Diagnosis , Emergency Service, Hospital , Incidence , Lung , Pneumothorax , Polyglactin 910 , Rupture , Sutures , Thorax , Tomography, X-Ray Computed , TransportationABSTRACT
The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.