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Näder Helmy, Andreas Platz, Reto Stocker, Otmar Trentz |
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Background: Tracheobronchial injuries due to blunt chest trauma are rate and occur in about 0.2-5% of patients. In this study, the pattern of injury is analyzed and the importance of careful clinical examination outlined. Diagnosis is confirmed by means of bronchoscopy.
Patients and Methods: Between 1993-2000, 1,243 patients with an ISS \geq 17 were admitted to the Trauma Division of the University Hospital Zurich, Switzerland. In only six of them (0.5%), a ruptured bronchus following blunt chest trauma was identified. All patients had sustained severe associated injuries with a mean ISS of 47.2 points (range, 34-56 points). In five patients presenting with an extended subcutaneous emphysema at the time of admission, an air leakage persited after immediate tube thoracostomy, one patient showed continuous tracheal bleeding. Diagnosis was confirmed bronchoscopically and an emergency thoracotomy performed in all six patients.
Results: In four patients the main bronchus on the right side was sutured, in one patient a wedge resection became necessary, and in one patient with additional lung laceration a pneumonectomy was performed which resulted in intraoperative death due to acute pulmonary failure. Three of six patients have survived and show no sequelae 3, 36, and 48 months after trauma, respectively.
Conclusions: Multiply injured patients with blunt chest trauma presenting with an extended subcutaneous emphysema and persistent air leakage after tube thoracostomy are at high risk of lesions of the tracheobronchial tree. Bronchoscopy will confirm the diagnosis. Therapy consists in repair of the ruptured bronchus as "day 1 surgery". |
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