title: [Sleeve resection of right main bronchus for posttraumatic bronchial stenosis].
abstract: BACKGROUND
  Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. A high index of clinical suspicion and accurate interpretation of radiological findings are necessary for prompt surgical intervention with primary repair of the airway. Delays in treatment increases the risk of partial to complete bronchial stenosis.
  
  
  METHODS
  A 21 years old male was admitted to our hospital following a workplace accident. A chest radiograph showed bilateral pneumothorax, cephalic and mediastinal emphysema. Chest tubes were placed on each side, with full pulmonary expansion and remission of emphysema. Minimal lesions of the right main bronchus were found at fiberoptic bronchoscopy. Daily chest X-rays showed an uncomplicated recovery. A stenosis was suspected due to right lung pneumonia evolving under specific antibiotherapy. Right main bronchus posttraumatic stricture was diagnosed by fiberoptic bronchoscopy. He underwent a right lateral thoracotomy with sleeve resection of stenotic bronchi. Control bronchoscopy reveals main bronchus widely patent with untraceable suture line.
  
  
  CONCLUSIONS
  Main bronchus rupture in blunt chest trauma is an additive effect of chest wall compression between two solid surfaces, traction on the carina and sudden increase in intraluminal pressure. Symptoms may vary: soft air leak, pneumothorax or limited mediastinal emphysema. Bronchoscopy should be performed immediately or when available. Granulation tissue leads to progressive bronchial obstruction, with distal infection and permanent parenchymal damage. Sleeve resection of the stenosed segment is the treatment of choice and restores fully the lung function.
  
  
  CONCLUSIONS
  Rupture of main bronchus is a complication of blunt chest trauma. Flexible bronchoscopy is useful and reliable for early diagnosis of traumatic tracheobronchial injuries. Delayed diagnosis can lead to lung parenchyma alteration due to retrostenotic pneumonia. Resection and end-to-end anastomosis is the key of successful in these cases.
authors.affiliation: Clinica Chirurgie Toracică I, Institutul de Pneumologie, "Marius Nasta", Bucureşti. andrei.bobocea@gmail.com
authors.forename: Andrei Cristian
authors.initials: AC
authors.lastname: Bobocea
authors.forename: Radu
authors.initials: R
authors.lastname: Matache
authors.forename: Mihaela
authors.initials: M
authors.lastname: Codreşi
authors.forename: Ciprian
authors.initials: C
authors.lastname: Bolca
authors.forename: Ioan
authors.initials: I
authors.lastname: Cordoş
mesh_terms: D000062:Accidents, Occupational; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001980:Bronchi / Q000293:injuries* / Q000601:surgery*; D001982:Bronchial Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D001999:Bronchoscopy; D003251:Constriction, Pathologic / Q000209:etiology; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011014:Pneumonia / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D013898:Thoracic Injuries / Q000601:surgery; D019616:Thoracic Surgical Procedures; D013908:Thoracotomy; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents