J Korean Med Sci.  2006 Jun;21(3):555-558. 10.3346/jkms.2006.21.3.555.

Delayed Bronchostenosis After Blunt Chest Trauma in Children: CT and Pathologic Findings

• Yoon HK
• Kim TS
• Han J
• Ahn KM
• Shim YM

• KMID: 1778444
• DOI: http://doi.org/10.3346/jkms.2006.21.3.555

Abstract

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.

Keyword

Bronchial Injuries; Wounds and Injuries; Computed Tomography; Trauma; Multiple Trauma

MeSH Terms

Wounds, Nonpenetrating/*diagnosis
Tomography, X-Ray Computed/*methods
Time Factors
Thoracic Injuries/*diagnosis
Male
Humans
Constriction, Pathologic
Child, Preschool
Child
Bronchial Neoplasms/*pathology
Bronchi/*injuries/pathology
Accidents, Traffic

Figure

• 

  Fig. 1 7-yr-old boy with delayed bronchostenosis after recent blunt chest trauma. (A) Initial anteroposterior chest radiograph shows paramediastinal radiolucency suggestive of pneumomediastinum (arrowheads) and subcutaneous emphysema in bilateral lower neck areas (arrows). (B) Initial non-enhanced CT scan (7-mm-collimation) shows a large amount of pneumomediastinum and subcutaneous emphysema in the anterior chest wall (arrows). Note contusional soft tissue swelling in the right lateral chest wall (arrowhead). (C) Anteroposterior chest radiograph obtained ten days after A shows total collapse of the left lung. Note obliteration of an air bronchogram of the left main bronchus (arrows). (D) Contrast-enhanced CT scan (7-mm-collimation) five days after C (15 days after injury) shows complete luminal obliteration at the mid-portion of the left main bronchus (arrowheads) with distal collapse of the left lung. (E) Photomicrograph of pathologic specimen obtained from bronchial segmental resection and anastomosis 22 days after blunt chest trauma shows near-complete obliteration of the bronchial lumen by fibrous scar and granulation tissue, which seem to be secondary to recent transmural injury (H and E, ×10).

• 

  Fig. 2 2-yr-old boy with delayed bronchostenosis after recent blunt chest trauma. Contrast-enhanced chest CT scan (3-mm-collimation) obtained 15 days after blunt chest trauma shows left upper lobe atelectasis. Note complete luminal obliteration of the proximal portion of the left upper lobe bronchus (arrowheads). Also note cavitary consolidations in the right upper lobe, suggestive of resolving traumatic lung cysts (arrows).

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