Blunt Traumatic Bronchial Transection

A 17-year-old man underwent a high-speed motorbike collision and was admitted into our intensive care unit. A chest computed tomographic scan showed a complete bronchial disruption at the level of the intermediate bronchus contained by mediastinal structures (Fig 1A,arrows), pneumothorax, and pneumomediastinum, and a right-sided upper and lower lobe parenchymal contusion, but no rib fractures. The transection followed an oblique path starting in front of the right upper lobe takeoff on its membranous face and reaching the middle lobe bronchus on its cartilaginous aspects (Fig 1B, arrows). The pneumothorax was treated with the placement of a chest tube, and a rigid bronchoscopy confirmed the total disruption of the intermediate bronchus and showed mediastinal structures protruding into the airway. Surgical repair was made by resecting the disrupted stumps and performing an end-to-end anastomosis between the right lower and middle lobe takeoff and the short residual intermediate bronchus [1Macchiarini P. Altmayer M. Go T. et al.Technical innovations of carinal resection for nonsmall-cell lung cancer.Ann Thorac Surg. 2006; 82: 1989-1997Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar]. The anastomosis was wrapped with a pleural flap. The patient was extubated on postoperative day 5 and was discharged after an uneventful course.