title: Bronchial rupture after intubation with double lumen endotracheal tube. Case report.
abstract: OBJECTIVE
  Tracheobronchial tree injuries are uncommon however severe complications after intubation or bronchoscopy. This report aimed at calling the attention to the difficult selective intubation, which has led to bronchial rupture associated to pneumomediastinum and hypertensive pneumothorax, with airway deformation and death by systemic inflammatory response.
  
  
  METHODS
  Male patient, 50 years old, with bronchopleural fistula secondary to bulla rupture in right lung upper lobe. After anesthetic induction it was difficult to intubate left bronchus. At the third attempt, patient developed hypoxemia, hypotension and extensive subcutaneous emphysema, being submitted to thoracic drainage for hypertensive pneumothorax. Fibrobronchoscopy has revealed left bronchus laceration. Patient evolved with hemoptysis, and left thoracotomy was necessary to suture bronchial laceration. Patient developed postoperative multiple organs dysfunction and evolved to death.
  
  
  CONCLUSIONS
  Selective intubation is a procedure to be carefully performed, being necessary the understanding of some risk factors and the early diagnosis of complications.
authors.affiliation: Hospital Vera Cruz, Belo Horizonte, MG. robertocarolina@uol.com.br
authors.forename: Roberto Cardoso
authors.initials: RC
authors.lastname: Bessa Júnior
authors.forename: Jaci Custódio
authors.initials: JC
authors.lastname: Jorge
authors.forename: Agnaldo Ferreira
authors.initials: AF
authors.lastname: Eisenberg
authors.forename: Wallace Lage
authors.initials: WL
authors.lastname: Duarte
authors.forename: Márcio Sérgio Carvalho
authors.initials: MS
authors.lastname: Silva