Bronchial injury with pneumomediastinum

Case contributed by Marius I. Diaconescu

Presentation

The patient is status post blunt trauma to the chest.

Patient Data

Age: 50 years
Gender: Male

There is patchy airspace consolidation in the posterior upper lobes with right upper lobe volume loss and consolidation in the superior segment of the left lower lobe with slight left lower lobe volume loss.

There is moderate pneumomediastinum dissecting to the neck and to the upper abdomen.

There is also bilateral nodular airspace opacification suggesting aspiration pneumonitis

There are 2 longitudinal lucent areas tracking along the airways communicating however with the sub-segmental that likely reflect bronchial injury.

There is a lucency in the center of the consolidated right upper lobe, likely a small laceration and there are bilateral small pneumothoraces.

Incidental note is made of a tracheostomy tube, an NG tube terminating in the stomach and a left chest tube its tip ending posteriorly at the left apex.

Case Discussion

Bronchial injury is a serious manifestation of chest trauma be it blunt, pentertating or iatrogenic.  

Bronchial tears can be suspected when there is a persistent pneumothorax after chest tube insertion. 

If there are findings suggestive of airway injury, diagnostic bronchoscopy can be recommended.

Supervised by: Dr. Geneviève Belley

Case courtesy of Dr. Joseph Cassulo

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Case information

rID: 77462
Published: 1st Jun 2020
Last edited: 2nd Jun 2020
System: Trauma, Chest
Inclusion in quiz mode: Included
Institution: McGill University

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