Clin Exp Emerg Med.  2017 Dec;4(4):250-253. 10.15441/ceem.16.177.

Management of right main bronchial rupture with a double lumen endotracheal tube in a patient with blunt chest trauma

Affiliations
  • 1Department of Emergency Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea. Limleeem@catholic.ac.kr
  • 2Department of Thoracic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea.

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.

Keyword

Thoracic injuries; Bronchial rupture; Double-lumen endotracheal tube

MeSH Terms

Adolescent
Airway Obstruction
Bronchi
Bronchoscopy
Chest Tubes
Drainage
Dyspnea
Emergencies
Humans
Intubation
Neck
Pneumothorax
Positive-Pressure Respiration
Rupture*
Shock
Subcutaneous Emphysema
Thoracic Injuries
Thoracic Wall
Thorax*
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