Diagnosis and treatment of traumatic intrathoracic major bronchial disruption.

Abstract

The purpose of this study was to review our experience with intrathoracic major bronchial disruptions due to trauma and to describe the diagnosis and treatment. A retrospective review was performed of major bronchial injuries managed in Kuwait (1995-2001), n=12. Clinical presentation, diagnostic evaluation, surgical management, and outcome were reviewed. The mechanism of injury involved blunt trauma in seven patients and penetrating trauma in five. Tachypnea and subcutaneous emphysema (occurring in 10, 9 of the patients, respectively) are common. Nine patients had pneumothorax and air leak after tube thoracostomy. The diagnosis was confirmed by bronchoscopy in all patients. The majority of the injuries were repaired primarily. Lung resection was necessary in two patients. Four patients sustained complications including death (two patients), atelectasis (one patient), and pneumonia (one patient). Follow-up bronchoscopy revealed no evidence of granulation tissue or stenosis at the site of repair. The diagnosis of intrathoracic major bronchial disruptions required a high index of suspicion and liberal use of bronchoscopy. The majority were repaired primarily with good outcome.