Combined Late Diagnosed Right Main Bronchial Disruption and Chylothorax From Blunt Chest Trauma

Partial rupture of the left main bronchus with left lung atelectasis due to blunt chest injury: a case report

Background

Bronchial injury is rare in blunt chest trauma, but can be life-threatening. The symptoms of patients with complete bronchial rupture are typical, and most of them are diagnosed in a timely manner and treated with surgery. However, for those with partial rupture of the bronchus, the symptoms are mild, the imaging results are negative, the possibility of delayed diagnosis is high, and serious complications can occur. Early diagnosis and treatment are key to treating this disease.

Case description

We report a 52-year-old woman with mild mediastinal emphysema after blunt chest trauma. Left whole-lung atelectasis appeared after a period of conservative treatment. Bronchoscopy revealed injury of the left main bronchus, and surgery was performed. The patient's lungs recovered well after surgery. CT (Computed tomography) examination during follow-up revealed that the structure of the left main bronchus was intact and unobstructed. The left lung was well recovered.

Conclusion

For patients with mild symptoms of blunt chest trauma, mediastinal emphysema and subcutaneous emphysema; no pleural effusion or pneumothorax; and a negative chest CT, laryngoscopy or bronchoscopy should be performed in a timely manner to ensure the stability of the respiratory and circulatory system and confirm whether there is tracheobronchial injury. Surgical treatment should be performed in a timely manner after localization and diagnosis.

Chylothorax caused by blunt chest trauma: a review of literature

Chylothorax is the accumulation of chyle in the pleural cavity that typically contains a high concentration of triglycerides. Blunt chest trauma is a rare cause. The aim of this study is to review all of the reported cases of chylothorax caused by blunt chest trauma. Available databases were explored systematically for the condition and the eligible papers were included. The literature search revealed 30 studies with 39 cases, 72.3% of the cases were male, and 21.7% of the patients were female. The age range varied between 4 and 75 years with a mean age of 35.8 years. All of the patients were diagnosed after fluid sampling from the pleural fluid by thoracentesis and/or chest tube insertion. About 71.4% of the patients were treated successfully by conservative management: others (28.6%) were managed surgically. Although it is a rare condition, persistent milky drainage after blunt chest trauma should raise the suspicion of chylothorax. Pleural fluid sampling is the cornerstone of the diagnosis. In the majority of the cases, conservative treatment is quite enough. Surgery is indicated whenever non-operative measures failed.

Refractory chylothorax following a transhepatic gunshot wound to the abdomen requiring unorthodox surgical treatment

An 18 year-old-male sustained a gunshot wound to the abdomen which required an uneventful hepatorrhaphy. He later returned with a large right effusion and was diagnosed with a chylothorax. The output was persistent despite conservative measures. Thoracotomy with attempted thoracic duct ligation was unsuccessful at decreasing the output. Re-exploration and ligation of the thoracic duct was required thru an abdominal approach.

Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma

BACKGROUND

Blunt thoracic trauma that results in tracheobronchial injury is difficult to diagnose. Many injuries are catastrophic and result in early mortality. Others are not immediately life threatening and are missed at initial presentation. Some of those injuries will later become symptomatic and will require medical attention. Ideal treatment in that situation is not yet clearly defined.

OBJECTIVES

The objective is to review the current literature of delayed diagnoses of traumatic tracheobronchial injuries, their management, and the results of the most common repair methods. An interesting case report from this institution is presented as well.

DESIGN

A Medline search of the English literature of delayed presentation of tracheobronchial injuries over the past 10 years was performed. Delayed diagnosis was defined as injuries not identified during the initial hospitalization.

RESULTS

The median time from initial presentation to diagnosis was 6 months. Dyspnea (56%) and pneumonia (39%) were the most common complaints. No difference in complications was observed between parenchymal sparing procedures and resections.

CONCLUSIONS

Despite delays in presentation and the radiographic appearance of destroyed distal lung, proximal injuries can often be repaired without sacrifice of distal lung parenchyma. Bronchial sleeve resections or end-to-end anastomosis can be performed safely in most situations.

Delayed bronchostenosis after blunt chest trauma in children: CT and pathologic findings

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.