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Tracheobronchial injury due to blunt chest trauma.

Mahmodlou R, Sepehrvand N - Int J Crit Illn Inj Sci (2015 Apr-Jun)

Bottom Line: Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes.The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus.Hence, a right superior lobectomy was performed and the postoperative course was uneventful.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran.

ABSTRACT
Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes. In this article, we briefly report the case of an 18-year-old man who was injured in a car accident and because of massive persistent air leakage (despite appropriate chest tube drainage), deemed to have a deep tracheobronchial injury. Due to a rapid drop in the patient's O2 saturation, he underwent an anterolateral thoracotomy. Endotracheal intubation was performed under direct visualization. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed and the postoperative course was uneventful.

No MeSH data available.


Related in: MedlinePlus

(Panel A) Chest radiography showed collapsed right lung (thick arrows), left deviated trachea (short arrows), and shifted heart (narrow long arrows) (Panel B) Computed tomography of the chest illustrating the collapsed right lung (thick arrows) and shifted heart (narrow long arrows)
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Figure 1: (Panel A) Chest radiography showed collapsed right lung (thick arrows), left deviated trachea (short arrows), and shifted heart (narrow long arrows) (Panel B) Computed tomography of the chest illustrating the collapsed right lung (thick arrows) and shifted heart (narrow long arrows)

Mentions: An 18-year-old man was injured in a car crash and was transported to the emergency department. On arrival, the patient was suffering from severe respiratory distress. Following initial examination, a chest tube was inserted immediately into the right hemithorax. However, there was a severe persistent air leak requiring a second chest tube. Despite the appropriate chest tube drainage, the patient was still in respiratory distress and tachypneic, indicating a need for intubation. The patient's condition improved clinically after endotracheal intubation. The patient also underwent imaging. Chest radiography showed collapsed right lung (thick arrows), left deviated trachea (short arrows), and shifted heart (narrow long arrows; Figure 1, Panel A), which was confirmed by computed tomography of the chest (Figure 1, Panel B). Considering the high-energy nature of the crash, continued severe air leak, and failure of lung expansion with chest tube insertion, a tracheobronchial injury was suspected; the patient was taken emergently to operating room for bronchoscopic evaluation. Upon arrival to the operating room, the patient's saturation precipitously dropped with hemodynamic compromise; therefore, an anterolateral thoracotomy was performed without prepping and positioning. The right mainstem bronchus was completely detached from the carina and the tip of the endotracheal tube was in the mediastinum. Under direct visualization, the tracheal tube was advanced into the left mainstem bronchus with a rapid improvement in hemodynamics and saturations. Then, the patient was positioned for posterolateral thoracotomy, and a posterolateral thoracotomy was performed in line with the previous incision. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the rest of it was crushed as far as the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed. Thereafter, an end-to-end anastomosis was done between the bronchus intermedius and the carinal stump. The postoperative course was uneventful. A six-month follow up revealed no complications.


Tracheobronchial injury due to blunt chest trauma.

Mahmodlou R, Sepehrvand N - Int J Crit Illn Inj Sci (2015 Apr-Jun)

(Panel A) Chest radiography showed collapsed right lung (thick arrows), left deviated trachea (short arrows), and shifted heart (narrow long arrows) (Panel B) Computed tomography of the chest illustrating the collapsed right lung (thick arrows) and shifted heart (narrow long arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477389&req=5

Figure 1: (Panel A) Chest radiography showed collapsed right lung (thick arrows), left deviated trachea (short arrows), and shifted heart (narrow long arrows) (Panel B) Computed tomography of the chest illustrating the collapsed right lung (thick arrows) and shifted heart (narrow long arrows)
Mentions: An 18-year-old man was injured in a car crash and was transported to the emergency department. On arrival, the patient was suffering from severe respiratory distress. Following initial examination, a chest tube was inserted immediately into the right hemithorax. However, there was a severe persistent air leak requiring a second chest tube. Despite the appropriate chest tube drainage, the patient was still in respiratory distress and tachypneic, indicating a need for intubation. The patient's condition improved clinically after endotracheal intubation. The patient also underwent imaging. Chest radiography showed collapsed right lung (thick arrows), left deviated trachea (short arrows), and shifted heart (narrow long arrows; Figure 1, Panel A), which was confirmed by computed tomography of the chest (Figure 1, Panel B). Considering the high-energy nature of the crash, continued severe air leak, and failure of lung expansion with chest tube insertion, a tracheobronchial injury was suspected; the patient was taken emergently to operating room for bronchoscopic evaluation. Upon arrival to the operating room, the patient's saturation precipitously dropped with hemodynamic compromise; therefore, an anterolateral thoracotomy was performed without prepping and positioning. The right mainstem bronchus was completely detached from the carina and the tip of the endotracheal tube was in the mediastinum. Under direct visualization, the tracheal tube was advanced into the left mainstem bronchus with a rapid improvement in hemodynamics and saturations. Then, the patient was positioned for posterolateral thoracotomy, and a posterolateral thoracotomy was performed in line with the previous incision. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the rest of it was crushed as far as the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed. Thereafter, an end-to-end anastomosis was done between the bronchus intermedius and the carinal stump. The postoperative course was uneventful. A six-month follow up revealed no complications.

Bottom Line: Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes.The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus.Hence, a right superior lobectomy was performed and the postoperative course was uneventful.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran.

ABSTRACT
Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes. In this article, we briefly report the case of an 18-year-old man who was injured in a car accident and because of massive persistent air leakage (despite appropriate chest tube drainage), deemed to have a deep tracheobronchial injury. Due to a rapid drop in the patient's O2 saturation, he underwent an anterolateral thoracotomy. Endotracheal intubation was performed under direct visualization. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed and the postoperative course was uneventful.

No MeSH data available.


Related in: MedlinePlus