PMC5651686_01
A chest roentgenogram taken at the patient's initial presentation showing pneumomediastinum, left clavicular fracture, and left pneumothorax. Eight days later, there was complete obstruction of the left lung, as evidenced in a reconstructed coronal view of a chest computed tomography.
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Three-dimensional (3D) reconstruction view of the tracheobronchial tree showed total obstruction of the left main bronchus proximal to the second carina (Fig. 1).
Left main bronchus sleeve resection and anastomosis were performed with robotic-assisted surgery. After looping of the aorta (triangle), the proximal and distal ends (star) of the left main bronchus were identified (A), and after resection of the obstructive lesion, anastomosis was performed with interrupted sutures using 4-0 polydioxanone (B). Bronchoscopic examination (C) at 2 weeks after reconstruction showed healed anastomosis with good luminal patency of the left main bronchus. (D) Follow-up chest roentgenogram at 2 months showed bilateral full lung expansion.
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Segmental resection of the severe fibrosis of left main bronchus was done until spillage of bronchial secretions distally was found (Fig. 2A). The stumps of both the proximal and distal ends were then both trimmed, and end-to-end anastomosis was performed using interrupted 4-0 polydioxanone sutures (Fig. 2A, B). Two weeks later post-operative bronchoscopy showed good healing of the anastomosis of the left main bronchus with luminal patency (Fig. 2C). Follow-up CXR at 2 months showed bilateral full lung expansion (Fig. 2D).