Abstract
Introduction
Tracheobronchial injuries (TBI) represent a rare but potentially life-threatening condition requiring prompt recognition and multidisciplinary management. Clinical signs may include subcutaneous or mediastinal emphysema, hemoptysis, and increased airway resistance, especially in intubated patients. Rapid diagnosis using CT and bronchoscopy is essential to guide treatment. Management strategies vary depending on the etiology, ranging from conservative approaches in iatrogenic injuries to surgical repair in cases of blunt or penetrating trauma. Early airway stabilization and treatment of associated life-threatening injuries are critical. The objective of this article is to present a rare case of complete right main bronchus rupture following blunt trauma and highlight diagnostic and surgical challenges.
Case Presentation
A 35-year-old male presented with dyspnea and chest pain following blunt chest trauma. Initial evaluation revealed a right-sided tension pneumothorax with subcutaneous emphysema, which was managed by chest tube drainage. Persistent air leakage prompted a chest CT on day 8 post chest tube insertion, raising suspicion of right main bronchus rupture. Flexible bronchoscopy performed on day 9 post chest tube insertion demonstrated bronchial stenosis without an obvious defect. Definitive diagnosis was established intraoperatively on day 10 post chest tube insertion, confirming a complete circumferential rupture of the right main bronchus. The patient underwent right posterolateral thoracotomy with end-to-end bronchial reimplantation, followed by an uneventful recovery. Follow-up bronchoscopy showed a well-healed bronchial anastomosis.
Conclusion
This case underscores the practical challenges clinicians face in recognizing and diagnosing tracheobronchial injuries after blunt trauma. When a pneumothorax persists despite adequate chest tube drainage, frontline providers must consider early advanced imaging and bronchoscopy, even in resource‑limited settings, because definitive diagnosis may sometimes only be confirmed intraoperatively. Early surgical intervention, once diagnosis is suspected or confirmed, can yield excellent outcomes.