Tracheobronchial injury after blunt thoracic trauma-lessons to learn in diagnosis, treatment, and postoperative care: a case series

Background: Tracheobronchial injury (TBI) is the subsuming term to describe rare and mostly traumatic damage to the tracheobronchial tree. Prehospital mortality is significant. TBI patients may face delayed diagnosis, challenging perioperative care, and prolonged recovery. The focus of this case series is to identify issues that represent common hurdles and potential problems in the diagnosis, treatment, and postoperative care of patients with TBI.

Case description: This is a single-center retrospective case-series study of four patients who experienced TBI following blunt thoracic trauma in the study period from January 1, 2020, to December 31, 2023. The mean age of the patients was 48 years, with patient age ranging from 24 to 59 years. One patient was female and the other three were male. Two patients sustained injuries to the main bronchi, while the others sustained injuries to more peripheral parts of the tracheobronchial tree. Three patients were secondary transfers to our hospital, while the other was a primary admission. All four patients underwent surgery for their TBI. The duration of hospitalization ranged from 10 to 60 days. The two patients with main stem bronchus injury required the longest hospitalization. The same two patients required extracorporeal membrane oxygenation therapy. We experienced no mortality, and all patients were discharged for post-hospital rehabilitation.

Conclusions: TBI management requires a multidisciplinary and experienced team. One must be aware of the classic clinical presentation: dyspnea, soft tissue emphysema, and hemoptysis. Cases in which a history of trauma is associated with dyspnea and/or chest wall/mediastinal emphysema require early bronchoscopy as the diagnostic gold standard. The use of "Minimum-intensity projection" (MinIP) reconstructions can help identify TBI in computed tomography scans. Extracorporeal membrane oxygenation therapy is to be considered in selected cases. Surgical repair must focus on preventing parenchymal loss by reconstructing the bronchial defect while avoiding anatomical resection. Postoperative care should consider the possibility of bronchial denervation and its potential complications.