Complete Rupture of Right Main Bronchus Coursing with Expanded Lung

Abstract

A 17-year-old male patient whose chest was run over by a tractor was admitted to our hospital with a history of blunt trauma. He was referred to us from a another hospital where he was intubated with a single- lumen endotracheal tube and given assisted mechanical ventilation support. Intercostal drains were inserted into the right and left sides of the chest. Massive subcutaneous emphysema, pneumomediastinum and expansion defect were detected in the left lung on chest X-ray. Fiberoptic bronchoscopy was performed. At the carina level, it was seen that the right main bronchus was completely ruptured from the trachea. Immediate thoracotomy was planned for the patient. The rupture was primarily repaired. On the seventh postoperative day, incomplete expansion of the left lung was detected. The patient was reoperated. Necrotic tissues and hematoma in upper lobe of left lung were cleared. In this case, we emphasized that bronchoscopy is the most important procedure in the diagnosis of tracheobronchial injury.

Özet

On yedi yaşında erkek hasta traktörün göğsünün üzerinden geçmesi sonucu künt travma öyküsü ile hastanemize getirildi. Hasta perifer hastanede tek lümenli endotrakeal tüp ile entübe edilmiş ve mekanik ventilasyon desteği verilmiş. Göğüs sağ ve sol tarafına interkostal dren uygulanmış. Akciğer grafisinde yaygın cilt altı amfizem, pnömomediastinum ve sol akciğerinde ekspansiyon kusuru vardı. Fiberoptik bronkoskopi yapıldı. Karina seviyesinde sağ ana bronşun trakeadan komplet rüptüre olduğu görüldü. Hastaya acil torakotomi planlandı. Rüptür primer onarıldı. Postop 7. gün sol akciğerde ekspansiyon kusuru vardı. Hasta yine opere edildi. Sol akciğer üst lobdaki nekrotik dokular ve hematom temizlendi. Bu olguda, bronkoskopinin trakeobronşial yaralanmanın teşhisinde en önemli prosedür olduğunu vurguladık.