title: Rupture of the right main bronchus: a case of a 4-year-old girl.
abstract: Tracheobronchial rupture after a blunt chest trauma is rare, especially in children. If the diagnosis is overlooked, severe ventilatory complications or mediastinitis may occur. We describe a case of a 4-year-old girl with a rupture of the right main bronchus after she was hit by a frame of steel (like a mini goal) that fell down while she was playing. The diagnosis was initially missed owing to a variety of symptoms. Difficulty with ventilation and persistent air leak after insertion of a chest tube in the case of a pneumothorax is suspect for a tracheobronchial rupture. This emphasizes once again the importance of the concept of rechecking and searching for the underlying cause when a pneumothorax persists. Bronchoscopy is the gold standard in establishing the diagnosis. Surgical treatment is in most cases the best option, especially in a ventilated patient. Without treatment mortality rates are up to 30%. In conclusion, tracheobronchial rupture should be excluded if mediastinal emphysema or a persistent air leak is present after a blunt thoracic trauma.
authors.affiliation: Department of Anaesthesiology, VU University Medical Centre, 1007 MB Amsterdam, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Nugteren
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
authors.forename: Frans B
authors.initials: FB
authors.lastname: Plötz
mesh_terms: D001980:Bronchi / Q000293:injuries*; D002574:Cervical Vertebrae / Q000293:injuries; D002675:Child, Preschool; D002968:Clavicle / Q000293:injuries; D005260:Female; D006801:Humans; D009104:Multiple Trauma / Q000601:surgery; D009333:Neck / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D012121:Respiration, Artificial; D012421:Rupture; D012887:Skull Fractures / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications*