Left main bronchial rupture: bronchoscopy and chest CT

A 72-year-old woman presented to our clinic with chronic cough. A chest CT scan showed an extrapleural lesion in the left upper lobe, suggestive of intercostal nerve schwannoma (Figure 1A). The patient was admitted for tumor resection by left video-assisted thoracoscopy. Intubation with a left-sided double-lumen endobronchial tube was required. The patient was admitted to the ICU and was successfully extubated. Twenty-four hours later she presented with subcutaneous emphysema in the neck, and a chest CT scan showed pneumomediastinum (Figure 1B). An emergency bronchoscopy was performed, showing a 3-cm rupture of the left main bronchus (Figures 1C and 1D). Given the clinical stability of the patient, muscle relaxants, oxygen therapy, and cough suppressants were prescribed, and a decision was made for conservative management with close monitoring. Four A D B E months later, a bronchoscopy was performed, showing scar tissue and resolution of the rupture (Figure 1E). Bronchial rupture after intubation with a double-lumen endobronchial tube has rarely been reported,(1) and mortality can be as high as 23%. Although bronchoscopy is the gold standard, chest CT can aid in locating the injury.(2) Mild symptoms and small ruptures can be managed with conservative treatment.(1)