Emergency repair of complete right main bronchial transection after blunt chest trauma: a case report.

BACKGROUND

Tracheobronchial injury following blunt chest trauma is an uncommon but potentially fatal condition that is frequently underrecognized because of nonspecific early findings. Right main bronchial injuries are particularly important because they often occur near the carina and may present with persistent pneumothorax, pneumomediastinum, extensive subcutaneous emphysema, and failure of lung re-expansion after tube thoracostomy.

CASE PRESENTATION: We report the case of a 16-year-old, previously healthy male who sustained blunt chest trauma after a wall collapsed onto him. He presented with severe respiratory distress, agitation, chest pain, cyanosis, and profound hypoxemia. Chest radiography demonstrated a complete right-sided pneumothorax with a fallen lung sign. Emergency computed tomography confirmed a complete right-sided pneumothorax, marked pneumomediastinum, and a contralateral pulmonary contusion. Despite right-sided chest tube insertion, a massive, continuous air leak persisted, and the right lung failed to re-expand adequately.

CASE DISCUSSION: Emergency right thoracotomy revealed bulging mediastinal pleura and complete transection of the right main bronchus just proximal to its bifurcation. The proximal and distal bronchial stumps were mobilized and repaired using an interrupted end-to-end bronchial anastomosis, followed by pleural flap reinforcement. Intraoperative air-leak testing was negative, and complete right lung re-expansion was achieved. This case highlights the classic but often overlooked diagnostic clues of major tracheobronchial injury and supports early lung-preserving repair when viable tissue is present.

CONCLUSION

Complete right main bronchial transection should be suspected following blunt chest trauma when a pneumothorax is associated with pneumomediastinum, a massive, persistent air leak, and failure of lung re-expansion after tube thoracostomy. Prompt recognition and emergency primary repair can restore airway continuity, preserve the lung, and result in satisfactory clinical respiratory recovery.