A Classic Image of Complete Right Main Bronchus Avulsion

Isolated Complete Rupture of Left Main Bronchus after Blunt Chest Trauma

“…Early diagnosis and treatment are essential to preserve life and to prevent complications such as airway stenosis and mediastinitis. Primary reconstruction with preservation of healthy lung parenchyma is the treatment of choice [6,18,19]. A very important factor for determining the outcome is close collaboration of anesthesiologists and surgeons.…”

Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the "fallen lung" sign

“…Finally, bronchial lesions are frequently associated with bilateral upper rib fractures (Fig. 1 a,b) [2,3,6,7,8,9]. Semi-indirect signs have rarely been reported, such as oblique orientation or extraluminal position of the endotracheal tube, and overdistension of the endotracheal balloon cuff [3,6].…”

“…Semi-indirect signs have rarely been reported, such as oblique orientation or extraluminal position of the endotracheal tube, and overdistension of the endotracheal balloon cuff [3,6]. Finally, direct radiological signs feature interruption of the radiolucent lumen, sharp angulation described as a ªbayonet deformityº, other distorsions of the normal tracheal air column [2,3,6,7,8,9], and the fallen lung sign, originally described by Oh et al in 1969 [4] and by Kumpe et al in 1970 [5]. Air leak through the lacerated bronchial wall leads to lung collapse.…”

“…Their detection in the emergency room is difficult and frequently delayed. It relies on a clinical suspicion, relating to the accident biomechanics [1], and on clinical or radiological indirect signs, such as pneumothorax, pneumomediastinum, and/or subcutaneous emphysema [1,2,3]. Diagnosis of blunt tracheo-bronchial lesions is definitely assessed by tracheo-bronchoscopy [1]; however, the admission radiological survey may provide direct signs of blunt tracheo-bronchial lesions, among which, the ªfallen lungº sign, initially reported by Oh et al [4] and Kumpe et al [5], is seen on plain films.…”

Lesões da traquéia e grandes brônquios

“…Com a evolução do quadro, novas radiografias e a tomografia linear poderão detectar alterações que não eram evidentes logo após o trauma. 1,9,26 A tomografia computadorizada helicoidal é capaz de fornecer dados adicionais e detectar as lesões traqueobrônquicas. A ressonância magnética produz imagens em múltiplos planos, com detalhes anatômicos da traquéia, carina, brônquios principais, vasos mediastinais e outras estruturas, sem necessidade do uso de contraste.…”