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Case Reports
, 11 (5), R94

Chest Computed Tomography With Multiplanar Reformatted Images for Diagnosing Traumatic Bronchial Rupture: A Case Report

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Case Reports

Chest Computed Tomography With Multiplanar Reformatted Images for Diagnosing Traumatic Bronchial Rupture: A Case Report

Morgan Le Guen et al. Crit Care.

Abstract

Introduction: Unnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity.

Methods: Three-dimensional reconstruction of the airways using a workstation connected to a multidetector chest computed tomography (CT) scanner may change the diagnostic strategy in patients with blunt chest trauma with clinical signs evocative of bronchial rupture.

Results: In this case report of a young motor biker, a complete disruption of the intermediary trunk was first misdiagnosed using standard chest helical CT and bronchoscopy. Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed. Follow-up using CT with three-dimensional reconstructions evidenced a bronchial stenosis located at the site of the rupture.

Conclusion: The present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.

Figures

Figure 1
Figure 1
Bedside chest radiography performed immediately after admission. Bilateral pneumothorax (large arrows), pneumomediastinum (thin arrows) and extensive subcutaneous emphysema are visible.
Figure 2
Figure 2
Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower pulmonary vein (white arrow). (d) Coronal view demonstrating multiple areas of alveolar consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).
Figure 3
Figure 3
Second thoracic computed tomography scan on day 2 (axial and oblique views). (a) The intermediate trunk is disrupted with a visible posterior wall defect below the origin of the right upper lobe bronchus (arrow). Note the persisting right pneumothorax despite adequate chest tube drainage. (b) An abnormal lucency raising the possibility of a bronchial disruption is seen on the oblique view.
Figure 4
Figure 4
Coronal and oblique views of three-dimensional reconstructions of the tracheobronchial tree. The (a) coronal and (b) oblique views demonstrate the disruption of the intermediary trunk with an abnormal lucency connected to it (white arrow) and show the partial visualization of segmental branches of the right-lower-lobe bronchus (*).
Figure 5
Figure 5
Computed tomography scan performed 2 weeks following surgery. (a) Complete recovery of the pulmonary contusion (axial slice at the level of the lower lobes). (b) The three-dimensional reconstruction of the tracheobronchial tree, however, demonstrates a bronchial stenosis (white arrow) at the site of surgical repair.

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