Asian Cardiovasc Thorac Ann 2003;11:276
© 2003 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Complete Bronchial Rupture after Blunt Thoracic Trauma
Theodor Tirilomis, MD,
Markus Roessler, MD1,
Federico Saldaña, MD
Department of Thoracic, Cardiac & Vascular Surgery
1 Departement of Anesthesiology, University Hospital Göttingen, Göttingen, Germany
For reprint information contact: Theodor Tirilomis, MD Tel: 49 551 39 6025 Fax: 49 551 39 6002 email: theodor.tirilomis{at}med.uni-goettingen.de Department of Thoracic, Cardiac & Vascular Surgery, University Hospital Göttingen Robert-Koch-Str. 40, D-37075 Göttingen, Germany.
A 22-year-old man suffered injuries as a front passenger in a motor vehicle collision. After being rescued from the car, he was intubated on-site due to progressive respiratory failure and admitted to a hospital. A radiographic examination revealed multiple right-sided rib fractures with bilateral pneumothorax and pneumomediastinum. Intercostal tubes were inserted in both sides of the chest. After primary treatment, the patient was transferred to our hospital for evaluation of the concomitant cerebral trauma and a multitude of other injuries.
On admission, the patient presented with a massive subcutaneous emphysema on the right side of the thorax and continuous air leakage through the right-sided drainage. Fiberoptic bronchoscopy revealed a right bronchial rupture. Emergency surgery was carried out via a right-sided thoracotomy using a double-lumen tube. During surgery, the mediastinal pleura over the right main bronchus was found to be intact. After incision of the pleura, a complete transsection of the right main bronchus, 1 cm distal to the level of carina, and retraction of the distal part of the bronchial tree was observed (Figure 1
). Re-insertion of the main bronchus was successfully performed. In the early postoperative course, the left-sided double-lumen tube was used to achieve separate bilateral ventilation with minimal pressure on the suture of the bronchial tear. The postoperative course was uneventful and the patient recovered well. Following a final fiberoptic bronchoscopic control of the bronchus, he was discharged from the hospital 3 weeks later.
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Figure 1. Operative view showing the complete transsection of the right main bronchus near to the level of carina and retraction of the distal part (< indicates the proximal part of the transsected bronchus and * the distal part).
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