Blunt thoracic injury is most commonly due to motor vehicle accidents. Although it is uncommon, complete bronchial disruption can occur as part of such injury; when it does, it is life-threatening. A 17-year-old man suffered complete transection of a bronchus as a result of an automobile accident and was brought to our emergency service. Initially, he had respiratory distress and persistent pneumothorax and expanding subcutaneous air despite multiple tube thoracos-tomies. Bronchoscopy confirmed complete disruption of the right mainstem bronchus just below the carina. One-lung ventilation during surgery permitted right upper lobectomy and repair of the transected bronchus. Postoperative care included high-frequency ventilation to minimize airway pressure and reduce the possibility of pneumothorax. Secretions and atelectasis complicated recovery, with the surgical repair site of the bronchus apparently narrowed by edema. Atelectasis recurred after hospital discharge and required the patient's readmission 2 months after surgery. At that time the anastomosis appeared stenotic due to granulation tissue, which was excised by YAG laser. Subsequent follow-up has revealed no further complications.
K. G. Davis (Tue,) studied this question.