2001 Volume 15 Issue 2 Pages 99-103
Between January 1980 and March 1999, 229 patients were treated for chest trauma. Twenty -three failed to respond to traditional conservative measures and underwent emergency thoracotomy. The indications for thoracotomy were massive hemothorax/profuse air leak not responding to chest tube suction in 23 patients. In each, an extensive pulmonary laceration or injuries of major vessels were found. The pulmonary lacerations were treated by lobectomy/ pneumonectomy in four patients and by suture repair in eighteen. Extensive pulmonary laceration is a significant cause of morbidity and death among patients with blunt chest trauma. Twenty patients survived, while three patients died. Death was caused primarily by extrathoracic trauma in all of the three who died.
Delayed diagnosis of tracheobronchial disruption resulting from blunt trauma continues to cause major morbidity and death. The initial clinical and rentogenographic findings are similar to those found in the larger group of patients with lesser trauma. However, continued and uncontrollable hemorrhage and massive air leakage characterized this entity. Tracheobronchial disruption should always be cosidered with massive blunt chest trauma. Bronchoscopy is indicated for unexplained pleural air leaks, lobar atelectasis, or persistent pneumothorax.
Awareness of the condition, a high degree of suspicion in patients who do not respond to conservative measures, and prompt thoracotomy may be life-saving.
