Bronchial rupture with a left-sided polyvinylchloride double-lumen tube

Bronchial rupture after intubation with a double-lumen endobronchial tube has been infrequently reported. Overinflation of the bronchial cuff was speculated to be a frequent cause of the bronchial damage. We report the case of a 78-year-old woman with non-small cell carcinoma of the right upper lobe. Her trachea and left main-stem bronchus were intubated with a left-sided polyvinylchloride (PVC) double-lumen endobronchial tube (Broncho-Cath(R) 37 Fr, Mallinckrodth Medical, Athlone, Ireland). She underwent an uneventful right upper lobectomy. At the end of the resection, the surgeons noticed the herniating cuff from the ruptured left main-stem bronchus. Laceration was repaired. Subsequent course of the patient was uneventful: she developed neither bronchial leak nor mediastinitis. Ten days later the patients was discharged home in a satisfactory condition. Factors that seem to increase the risk of injury by a double-lumen tube are discussed.