Primary repair of a completely ruptured intermediate bronchus after blunt chest trauma. Case report

Tracheobronchial injury is rare and often has a fatal course. The incidence is estimated from 0.8% to 5% in the scenario of blunt or penetrating chest trauma.

A 54-year-old male was brought to the emergency department after falling off his bicycle, with impact on head and right shoulder. At pre-hospital assessment, the patient had a free airway, gasping respiration (oxygen saturation 92%) with reduced vesicular breathing. Multiple rib fractures are palpable bilaterally, with subcutaneous emphysema. Computed tomography (CT) showed a large right-sided pneumothorax and consolidated lung lobes. After insertion of two chest tubes on the right, a refractory pneumothorax with large air leakage remained present. Subsequently, a bronchoscopy was performed, confirming a complete rupture of the right intermediate bronchus. Urgent surgical debridement and primary repair with an end-to-end running suture was performed. Rib osteosynthesis was additionally performed bilaterally, because of a flail chest on the right side and penetrating bone fragment on the left side. Respiratory function recovered uneventfully.

Airway injuries are uncommon but must always be suspected by the clinician during the early management of chest trauma. To prevent delayed diagnosis and potentially fatal outcome, low-threshold bronchoscopy is the diagnostic modality of choice to accurately confirm the lesion. Primary surgical repair remains the mainstay of the therapeutic management.