D Chen1, L Han, Y Hu, H Yin, H Zhao, H Li. 1. Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang 110001, China. chendongyi@usa.net
Abstract
OBJECTIVE: To evaluate the diagnosis and management of bronchial rutpture from blunt thoracic trauma. METHODS: A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tomography and bronchoscopy were performed on all patients. The surgical technique and complications were described. RESULTS: Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneumonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81% (25/31) of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, "drop lung" sign and marked radiodensity of hilum widened mediastinum. CONCLUSION: Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients.
OBJECTIVE: To evaluate the diagnosis and management of bronchial rutpture from blunt thoracic trauma. METHODS: A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tomography and bronchoscopy were performed on all patients. The surgical technique and complications were described. RESULTS: Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneumonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81% (25/31) of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, "drop lung" sign and marked radiodensity of hilum widened mediastinum. CONCLUSION: Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients.
Authors: Lori M van Roozendaal; Matthijs H van Gool; Roy T M Sprooten; Bart A E Maesen; Martijn Poeze; Karel W E Hulsewé; Yvonne L J Vissers; Erik R de Loos Journal: J Thorac Dis Date: 2018-09 Impact factor: 2.895