Abstract
Eleven cases of tracheobronchial rupture are described. Nine were the result of external non-penetrating trauma and all but three had other serious injuries. The remaining two were caused by endobronchial intubation. Of the cases caused by external injury, respiratory tract injury was confined to the cervical trachea in three. Two required tracheostomy and repair and the third was managed conservatively; all made satisfactory recoveries. Intrathoracic rupture was recognised on or soon after admission in three cases. One patient died of uncontrollable pulmonary haemorrhage before he could be operated on; immediate repair gave good long term results in the other two. In three cases rupture of the main bronchus was not recognised until complete obstruction developed three, five, and 12 weeks after the accidents. The strictures were resected and the lung re-expanded. Robertshaw endobronchial tubes ruptured the left main bronchus in two patients undergoing oesophageal surgery. Uneventful recovery followed immediate repair. The difficulty of confirming rupture of a major airway is discussed and the importance of conserving the lung when the diagnosis has been missed is emphasised.
Full text
PDF







Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Albers J. E., Rath R. K., Glaser R. S., Poddar P. K. Severity of intrathoracic injuries associated with first rib fractures. Ann Thorac Surg. 1982 Jun;33(6):614–618. doi: 10.1016/s0003-4975(10)60822-3. [DOI] [PubMed] [Google Scholar]
- Alyono D., Perry J. F., Jr Impact of speed limit. I. Chest injuries, review of 966 cases. J Thorac Cardiovasc Surg. 1982 Apr;83(4):519–522. [PubMed] [Google Scholar]
- Amauchi W., Birolini D., Branco P. D., de Oliveira M. R. Injuries to the tracheobronchial tree in closed trauma. Thorax. 1983 Dec;38(12):923–928. doi: 10.1136/thx.38.12.923. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Anderson K. D., Chandra R. Pneumothorax secondary to perforation of sequential bronchi by suction catheters. J Pediatr Surg. 1976 Oct;11(5):687–693. doi: 10.1016/0022-3468(76)90091-9. [DOI] [PubMed] [Google Scholar]
- BURKE J. F. Early diagnosis of traumatic rupture of the bronchus. JAMA. 1962 Aug 25;181:682–686. doi: 10.1001/jama.1962.03050340020005. [DOI] [PubMed] [Google Scholar]
- Bertelsen S., Howitz P. Injuries of the trachea and bronchi. Thorax. 1972 Mar;27(2):188–194. doi: 10.1136/thx.27.2.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Black J. B., Lawson R. A. Rupture of the bronchus following closed injury to the chest. J R Coll Surg Edinb. 1970 Jan;15(1):21–26. [PubMed] [Google Scholar]
- Brodsky J. B., Shulman M. S., Mark J. B. Airway rupture with a disposable double-lumen tube. Anesthesiology. 1986 Mar;64(3):415–415. doi: 10.1097/00000542-198603000-00038. [DOI] [PubMed] [Google Scholar]
- Burnell R. H., Ghadiali P. E., Joseph M. C., Paneth M. Management of critical valvular outflow obstruction in neonates. Thorax. 1970 Jan;25(1):116–119. doi: 10.1136/thx.25.1.116. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burton N. A., Fall S. M., Lyons T., Graeber G. M. Rupture of the left main-stem bronchus with a polyvinylchloride double-lumen tube. Chest. 1983 Jun;83(6):928–929. doi: 10.1378/chest.83.6.928. [DOI] [PubMed] [Google Scholar]
- Chesterman J. T., Satsangi P. N. Rupture of the trachea and bronchi by closed injury. Thorax. 1966 Jan;21(1):21–27. doi: 10.1136/thx.21.1.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Collins J. P., Ketharanathan V., McConchie I. Rupture of major bronchi resulting from closed chest injuries. Thorax. 1973 May;28(3):371–375. doi: 10.1136/thx.28.3.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crawford W. O., Jr Pulmonary injury in thoracic and non-thoracic trauma. Radiol Clin North Am. 1973 Dec;11(3):527–541. [PubMed] [Google Scholar]
- Davies D., Hopkins J. S. Patterns in traumatic rupture of the bronchus. Injury. 1973 Feb;4(3):261–264. doi: 10.1016/0020-1383(73)90049-1. [DOI] [PubMed] [Google Scholar]
- Deslauriers J., Beaulieu M., Archambault G., LaForge J., Bernier R. Diagnosis and long-term follow-up of major bronchial disruptions due to nonpenetrating trauma. Ann Thorac Surg. 1982 Jan;33(1):32–39. doi: 10.1016/s0003-4975(10)63195-5. [DOI] [PubMed] [Google Scholar]
- Dougall A. M., Paul M. E., Finely R. J., Holliday R. L., Coles J. C., Duff J. H. Chest trauma--current morbidity and mortality. J Trauma. 1977 Jul;17(7):547–553. [PubMed] [Google Scholar]
- ELLIS F. H., Jr, GRINDLAY J. H., EDWARDS J. E. The bronchial arteries. I. Experimental occlusion. Surgery. 1951 Nov;30(5):810–826. [PubMed] [Google Scholar]
- Foster J. M., Lau O. J., Alimo E. B. Ruptured bronchus following endobronchial intubation. A case report. Br J Anaesth. 1983 Jul;55(7):687–688. doi: 10.1093/bja/55.7.687. [DOI] [PubMed] [Google Scholar]
- Grover F. L., Ellestad C., Arom K. V., Root H. D., Cruz A. B., Trinkle J. K. Diagnosis and management of major tracheobronchial injuries. Ann Thorac Surg. 1979 Oct;28(4):384–391. doi: 10.1016/s0003-4975(10)63139-6. [DOI] [PubMed] [Google Scholar]
- Guernelli N., Bragaglia R. B., Briccoli A., Mastrorilli M., Vecchi R. Tracheobronchial ruptures due to cuffed Carlens tubes. Ann Thorac Surg. 1979 Jul;28(1):66–67. doi: 10.1016/s0003-4975(10)63395-4. [DOI] [PubMed] [Google Scholar]
- Heiser M., Steinberg J. J., MacVaugh H., 3rd, Klineberg P. L. Bronchial rupture, a complication of use of the Robertshaw double-lumen tube. Anesthesiology. 1979 Jul;51(1):88–88. doi: 10.1097/00000542-197907000-00022. [DOI] [PubMed] [Google Scholar]
- Jones W. S., Mavroudis C., Richardson J. D., Gray L. A., Jr, Howe W. R. Management of tracheobronchial disruption resulting from blunt trauma. Surgery. 1984 Mar;95(3):319–323. [PubMed] [Google Scholar]
- Kirsh M. M., Orringer M. B., Behrendt D. M., Sloan H. Management of tracheobronchial disruption secondary to nonpenetrating trauma. Ann Thorac Surg. 1976 Jul;22(1):93–101. doi: 10.1016/s0003-4975(10)63961-6. [DOI] [PubMed] [Google Scholar]
- LLOYD J. R., HEYDINGER D. K., KLASSEN K. P., ROETTIG L. C. Rupture of the main bronchi in closed chest injury; a reproduction of the injury in the experimental animal; discussion of the possible mechanisms involved. AMA Arch Surg. 1958 Oct;77(4):597–605. doi: 10.1001/archsurg.1958.04370010129012. [DOI] [PubMed] [Google Scholar]
- Logeais Y., Florent G. D., Danrigal A., Barre E., Maurel A., Vanetti A., Renault P., Galey J. J., Mathey J. Traumatic rupture of the right main bronchus in an eight-year-old child successfully repaired eight years after injury. Ann Surg. 1970 Dec;172(6):1039–1047. doi: 10.1097/00000658-197012000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mazzei E. A. Mulder DG: Closed-chest injuries to the trachea and bronchus. Arch Surg. 1970 Jun;100(6):677–680. doi: 10.1001/archsurg.1970.01340240045009. [DOI] [PubMed] [Google Scholar]
- McLeod B. J., Sumner E. Neonatal tracheal perforation. A complication of tracheal intubation. Anaesthesia. 1986 Jan;41(1):67–70. doi: 10.1111/j.1365-2044.1986.tb12707.x. [DOI] [PubMed] [Google Scholar]
- Mills S. A., Johnston F. R., Hudspeth A. S., Breyer R. H., Myers R. T., Cordell A. R. Clinical spectrum of blunt tracheobronchial disruption illustrated by seven cases. J Thorac Cardiovasc Surg. 1982 Jul;84(1):49–58. [PubMed] [Google Scholar]
- Oh K. S., Fleischner F. G., Wyman S. M. Characteristic pulmonary finding in traumatic complete transection of a main-stem bronchus. Radiology. 1969 Feb;92(2):371–passim. doi: 10.1148/92.2.371. [DOI] [PubMed] [Google Scholar]
- PAULSON D. L. Traumatic bronchial rupture with plastic repair. J Thorac Surg. 1951 Dec;22(6):636–645. [PubMed] [Google Scholar]
- Rahbar A., Chang F. C., Farha S. J. Rupture of the bronchus: Case report of successful resection and anastomosis in a 13-month-old infant. J Trauma. 1978 Feb;18(2):140–141. [PubMed] [Google Scholar]
- SCANNELL J. G. Rupture of the bronchus following closed injury to the chest; report of a case treated by immediate thoracotomy and repair. Ann Surg. 1951 Jan;133(1):127–130. doi: 10.1097/00000658-195101000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith B. A., Hopkinson R. B. Tracheal rupture during anaesthesia. Anaesthesia. 1984 Sep;39(9):894–898. doi: 10.1111/j.1365-2044.1984.tb06578.x. [DOI] [PubMed] [Google Scholar]
- Wagner D. L., Gammage G. W., Wong M. L. Tracheal rupture following the insertion of a disposable double-lumen endotracheal tube. Anesthesiology. 1985 Dec;63(6):698–700. doi: 10.1097/00000542-198512000-00026. [DOI] [PubMed] [Google Scholar]
- Wiot J. F. Tracheobronchial trauma. Semin Roentgenol. 1983 Jan;18(1):15–22. doi: 10.1016/s0037-198x(83)80006-6. [DOI] [PubMed] [Google Scholar]
- Woodring J. H., Fried A. M., Hatfield D. R., Stevens R. K., Todd E. P. Fractures of first and second ribs: predictive value for arterial and bronchial injury. AJR Am J Roentgenol. 1982 Feb;138(2):211–215. doi: 10.2214/ajr.138.2.211. [DOI] [PubMed] [Google Scholar]
- Wychulis A. R., Neville W. E. Tracheal and bronchial reconstructive procedures. Surg Gynecol Obstet. 1974 Sep;139(3):433–445. [PubMed] [Google Scholar]