PMC2556736_01
Bedside chest radiography performed immediately after admission. Bilateral pneumothorax (large arrows), pneumomediastinum (thin arrows) and extensive subcutaneous emphysema are visible.
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F1
As shown in Figure 1, bedside frontal chest radiography showed bilateral and compressive pneumothorax, pneumomediastinum and extensive subcutaneous emphysema.
Computed tomography scan following emergency chest tube drainage. Axial 1.25 mm thick sections with a lung window. (a) Persistent bilateral pneumothorax, pneumomediastinum and extensive subcutaneous emphysema. (b) Multiple lucencies around the right bronchial tree (curved arrow) precluding the correct recognition of the bronchial rupture. (c) The Macklin effect around the right lower pulmonary vein (white arrow). (d) Coronal view demonstrating multiple areas of alveolar consolidation in the right upper and lower lobes: intraparenchymal lucencies resulting from lung lacerations are visible on the right side (thick arrows).
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F2
II); and bilateral pneumothorax with a small hemothorax predominating on the left side, pneumomediastinum, pulmonary interstitial emphysema (Macklin effect), pneumopericardium, subcutaneous emphysema and multiple rib fractures (Figure 2). It has to be pointed out that the right-upper-lobe bronchus was displaced posteriorly without a characteristic CT fallen sign as described by Tack and colleagues.
Second thoracic computed tomography scan on day 2 (axial and oblique views). (a) The intermediate trunk is disrupted with a visible posterior wall defect below the origin of the right upper lobe bronchus (arrow). Note the persisting right pneumothorax despite adequate chest tube drainage. (b) An abnormal lucency raising the possibility of a bronchial disruption is seen on the oblique view.
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F3
The axial slice demonstrated a parietal defect of the posterior wall of the intermediate trunk (Figure 3).
Coronal and oblique views of three-dimensional reconstructions of the tracheobronchial tree. The (a) coronal and (b) oblique views demonstrate the disruption of the intermediary trunk with an abnormal lucency connected to it (white arrow) and show the partial visualization of segmental branches of the right-lower-lobe bronchus (*).
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F4
Multiple oblique reformations of the right lung and 3D reconstruction of the airways brought definitive evidence of a complete right bronchial disruption just below the origin of the upper right bronchus associated with a partial collapse of the right-middle lobe and of the right-lower lobe (Figure 4).
Computed tomography scan performed 2 weeks following surgery. (a) Complete recovery of the pulmonary contusion (axial slice at the level of the lower lobes). (b) The three-dimensional reconstruction of the tracheobronchial tree, however, demonstrates a bronchial stenosis (white arrow) at the site of surgical repair.
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F5
Transversal CT sections demonstrated a normal aeration of the right lung whereas 3D reconstruction of the airways demonstrated a short but tight bronchial stenosis located at the site of the initial rupture (Figure 5).