Surgical Management of a Traumatic Mainstem Bronchus Avulsion

Traumatic tracheobronchial tree injuries are rarely survivable. We present the case of a 31-year-old male patient who had a delayed discovery of a complete right mainstem bronchus avulsion following a motor vehicle collision. Despite initial respiratory stability, the patient rapidly deteriorated on hospital day 4. Flexible bronchoscopy was performed and demonstrated a right mainstem bronchus avulsion with endobronchial mediastinal adipose tissue partially obstructing and stabilizing the transected airway. The patient successfully underwent a right posterolateral thoracotomy with primary anastomosis of the right mainstem bronchus. High clinical suspicion for tracheobronchial injuries is required after high-speed acceleration-deceleration mechanisms resulting in blunt chest trauma.