Bronchial rupture in a young child: A case report

We report a case of bronchial rupture in a five-year-old boy with polytrauma after being hit by a motor vehicle. He was initially found to have a base of skull fracture, bilateral pulmonary contusions, lacerations and haemopneumothoraces, cardiac contusion, left first rib and right scapula fracture, extensive surgical emphysema, liver laceration and splenic laceration. At exploratory laparotomy he became difficult to ventilate with massive right-sided air leak. He returned to ICU where high-frequency ventilation was utilised. He required an exploratory thoracotomy which revealed an avulsed right middle bronchus from the right main bronchus which had not been visible on CT or bronchoscopy. Right middle lobectomy was performed, the bronchial rupture was sutured and chest drains were inserted to reinflate the right lung during his 3-week inpatient stay. His Trauma Revised Injury Severity Score (TRISS) predicted a 30% chance of survival from his injuries. He made excellent progress on the ward and was discharged for rehabilitation at his local medical service. Conclusion: Bronchial rupture is not always visible on CT and can cause ventilator air leak to develop many hours after the injury. 2014 Elsevier Ltd.