Bronchial tear consecutive to blunt chest trauma.

Tracheobronchial injuries following blunt chest trauma are rare and can be lethal. CT scan can help to diagnose it when a defect to the tracheobronchial wall is visible or to suspect it in front of indirect signs.

CASE

A 58‐year‐old woman was admitted to the ICU for a polytrauma following a high‐velocity traffic accident.

Physical examination showed multiple thoracoabdominal contusions and a subcutaneous emphysema, associated with dyspnea, low oxygen saturation at ambient air, and a low blood pressure.

A whole‐body scan was performed for injury assessment, and it revealed multiple severe lesions and fractures on the thoracic floor, with a left main bronchus tear (Figures 1 and 2), associated with pneumomediastinum (Figure 3), left hemopneumothorax, pulmonary contusions, and a subcutaneous emphysema.

FIGURE 1

Contrast‐enhanced coronal reformat CT image in the lung window showing a left main bronchus tear (Arrow)

FIGURE 2

Contrast‐enhanced axial CT image in the lung window showing the left main bronchus tear (Arrow). Note the pneumomediastinum, hemopneumothorax, and lung contusions

FIGURE 3

Pneumomediastinum (Arrow). Note the associated left pneumothorax

The evolution was marked by a rapid aggravation with respiratory failure and hemodynamic instability, requiring endotracheal intubation and vasopressors.

The patient, unfortunately, died soon after CT was performed, despite maximal supportive measures, due to respiratory distress and multiorgan failure.

DISCUSSION

Tracheobronchial injuries are rarely seen because most patients die before arriving at the emergency department. They have an incidence of 0.2%–8% of all cases of blunt chest trauma.

Bronchial lacerations are more common than tracheal lacerations, and they usually occur close to the carina. Pneumomediastinum and pneumothorax are the most common imaging findings, in addition to subcutaneous emphysema. The tracheobronchial wall defect, however, is not necessarily seen on CT.

CONFLICT OF INTEREST

No conflict of interest to be declared by the authors.

AUTHOR CONTRIBUTIONS

AN, SJ, and RS contributed to the conception, acquisition, analysis, interpretation of data, and drafted the manuscript. JE and RS critically revised the manuscript. All the authors have read and approved the final draft of the manuscript.

ETHICAL APPROVAL

Ethical approval is not required for de‐identified single case reports based on institutional policies.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.