Traumatic bronchial rupture--a case report.

Traumatic bronchial rupture is a rarity. Its incidence is about 1.5% to 3% in most series of blunt chest trauma. We report a patient who presented after a road traffic accident with an apparently persistent pneumothorax which failed to respond to emergency treatment. This was later discovered to be due to a traumatic bronchial rupture. It is difficult to diagnose traumatic bronchial rupture, the main reason being that it is often not considered by doctors caring for the patient with blunt chest trauma in the Accident and Emergency Department. Failure to recognise this condition contributes to its high mortality. The authors would like to recommend that emergency bronchoscopy be carried out in patients with blunt chest trauma to exclude this potentially treatable condition. This is especially so if there are suggestive clinical features, such as the presence of extensive and spreading subcutaneous emphysema, pneumomediastinum, pneumothorax, haemoptysis, fractures of the first two ribs and respiratory distress. A history of massive blunt force to the chest wall as a mechanism of injury should also prompt the trauma team to consider the need for emergency bronchoscopy.