Blunt chest trauma associated with bronchial rupture and cerebral air embolism. A case report.

Abstract

Thoracic injuries following blunt chest trauma represent a significant cause of morbidity and mortality in the pediatric population. Airway injuries, such as tracheal and bronchial rupture are quite rare with an incidence of 1-3%.  We present the case of a 17-year-old girl victim of major trauma after an intentional fall from a height of 12 meters who reported subcutaneous emphysema, bilateral pulmonary contusions, a slight apical left pneumothorax and massive pneumomediastinum. Following cardio-respiratory stabilization a flexible bronchoscopy was performed.  The complete avulsion of the left superior bronchus was found. Urgent thoracic surgery was performed obtaining the complete pulmonary recovery. Subsequent total body Computed Tomography (CT) control documented a large area of cortical-subcortical ischemia in the left parieto-occipital lobe. Cerebral Magnetic Resonance Imaging (MRI), performed on day 6, confirmed the findings and therefore cerebral air embolism was hypothesized. Following surgery and lung recovery patient regained consciousness and consequently discharged without any neurological or respiratory sequelae. Systemic Air Embolism (SAE) should always be suspected in case of chest trauma, especially if pneumomediastinum or pneumothorax are present and associated with neurological signs or Cerebral CT scan abnormalities. Tracheal and bronchial lesions should always be investigated and treated surgically as soon as possible in case of airway instability and/or respiratory failure.