Tracheobronchial lesions after blunt chest injury

Tracheobronchial lesions after blunt chest injury are seldom (0,5-0,7 %). Diagnostic and therapeutic strategies in 16 own cases and a review of the literature are presented. Own experiences: Locations of the lesions were main bronchus (10), bronchus intermedius (2), and trachea (4). Rupture was total in five cases, and partial in seven. In four patients the mucosa only was ruptured. Initial symptoms: Subcutaneous emphysema (13), pneumothorax (9) respiratory insufficiency (5), lung lesion (5), but tracheal bleeding in five cases only. Diagnosis mainly by bronchoscopy (8 early, 4 late), but in 4 cases after thoracotomy. Treatment: In cases of total rupture, there were three anastomoses of the bronchus and one of the trachea, and one pneumonectomy. In all partial ruptures, there was suturing of the lesion. Mucosa lesions were treated conservatively. Results: 1 empyema, 2 ex. leth. (bilateral pneumonia 7.d., multiple organ failure 20.d). Follow up: 9 patients free of symptoms, 5 patients with respiratory problems. The symptoms ''mediastinal emphysema and continuous air leakage through the chest tube or persistent atelectasis of the lung'' are indications for urgent bronchoscopy and early surgery. Long-term results are good in 70 %-90 % of the cases. Not diagnosed lesions can result in tracheobronchial stenosis and infections of the lung later on, to be treated by lung resection only. Total bronchial ruptures can result in strictures and non-infected atelectasis, resection of the stricture and reinflation of the lung being successful in 60 %-70 % of these late diagnosed cases.