Traumatic transection of main stem bronchus with unexpected clinical presentation- a case report

Tracheobronchial injury is very challenging in diagnosis and treatment. Highly suspicious airway injury and early diagnosis is recommended. We present a case of 39 years-old woman suffering from acute respiratory failure with bilateral hemo-pneumothorax and diffuse subcutaneous emphysema initially. She weaned from ventilator a few days later, but dyspnea recurred due to delayed diagnosis of complete disruption of right main bronchus. However, the image study was incompatible with clinical findings. It showed collapse of left lower lung and hyperinflation of right lung, instead of right pneumothorax or fallen-lung sign. Under the assistance of veno-venous extracorporeal membrane oxygenation, primary repair of right main bronchial injury was performed successfully. Finally, she recovered well uneventfully. In tracheobronchial injury, early diagnosis is a positive prognostic factor. The other important point is primary repair, instead of lobectomy or pneumonectomy.