COMBINED SUBCLAVIAN ARTERY RUPTURE AND DELAYED BRONCHIAL STENOSIS FROM BLUNT CHEST TRAUMA

A 23-year-old man suffered crush injury to the thorax resulting in rupture of the left subclavian artery and left main bronchus. The arterial injury was diagnosed immediately and successfully repaired. Despite the presence of bilateral pneumothoraces and mediastinal and chest wall emphysema the bronchial injury was not initially diagnosed because both lungs re-expanded with tube thoracostomies. The patient re-presented 5 weeks later with complete atelectasis of the left lung. Bronchoscopy revealed a fibrotic stenosis of the left main bronchus. The stenosed segment was completely excised and the cut ends anastomosed with full re-inflation of the lung.