The Great Role of Ventilator Parameters in Diagnosis of Right Main Bronchus Rupture Due to Blunt Chest Trauma.

Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistent air leak through the intercostal drain tube. Chest radiographs and chest computed tomography scans (CT scans) are highly suggestive of this extremely rare tracheobronchial injury. The present study reported a patient who was a 15-year-old boy. He was a case of a motor-car accident and was brought to the emergency room (ER) of Rajaie Hospital ( Shiraz, Iran) due to dyspnea and chest pain. The physical examination revealed a few crash injuries on his upper extremities, as well as subcutaneous emphysema in his neck. The chest X-ray revealed a right clavicular fracture, multiple rib fractures, a right pneumothorax (but no complete collapse or fallen lung), and also pneumo-mediastinum and subcutaneous emphysema. The chest CT revealed severe pulmonary contusion, severe right-sided pneumothorax, significant pneumo-mediastinum, subcutaneous emphysema, multiple right-side rib fractures, and mild displacement of the right main bronchus. Furthermore, no definitive signs of bronchial rupture were detected. Using a mechanical ventilator, the following parameters were revealed. The maximum pressure (Pmax)=7cm, H2o (was very low), plateau pressure (P. Plateau), and expiratory tidal volume (TV) were not detected due to insufficient amounts. Additionally, increasing TV did not change those values. Bronchial rupture is one of the most important and serious differential diagnoses in forceful chest traumas when the mechanical ventilator reveals low Pmax, very low P.platue, and expiratory TV, with no change in those values with increasing TV.