RESUMO
Tracheobronchial injuries (TBI) are a heterogenous group of sometimes life-threatening traumas with different management approaches. Symptoms are mediastinal and subcutaneous emphysema, bloody secretions from the airway or haemoptysis in alert patients, and high air leakage along the cuff or increased ventilatory resistance may be signs for TBI in intubated patients. The necessity of immediate clinical evaluation, CT-scan and bronchoscopic evaluation are essential for prompt diagnosis and classification as well as experienced air way management and treatment, these patients are best managed from interdisciplinary teams including thoracic surgeons. While iatrogenic tracheal membrane laceration from intubation can be treated by lesion bridging with ventilation tube, stent application, open operative repair or endoluminal repair, intraoperative accidental cuts should be repaired by direct suture or with vital tissue coverage in case of local ischemia. The management of blunt or penetrating injury is sequential and needs immediate establishment and maintenance of a secure patent airway to provide adequate oxygenation. The next step is the treatment of life-threatening collateral injuries like major hemorrhage, cranial trauma or major organ damage arranged in the trauma team. The treatment of penetrating injuries to the airway need operative exploration in almost every case with minimal local dissection and debridement followed by direct repair. Muscle flap coverage is useful in case of combined esophageal injury. Damage of the tracheobronchial tree after blunt trauma must be repaired by direct suture or local tissue sparing resection and anastomosis. These lesions can be missed in the initial phase and may become prominent with scar tissue formation, stenosis and atelectasis in the later phases.
RESUMO
INTRODUCTION: Mediastinal repositioning and the use of allogenic implants to obliterate the postpneumonectomy space is the main principle of postpneumonectomy syndrome (PPS) correction. We present a rare case with a PPS in combination with a congenital pectus excavatum. As a pectus excavatus deformity reduces retrosternal space, simple repositioning of the heart is impossible unless combined with a sternum elevation. PRESENTATION OF CASE: Two years after left sided pneumonectomy a 30 year old female was admitted with progressive exertional dyspnea and stridor and not able to do her basic activities. Chest CT-scan and bronchoscopy revealed severe right main bronchus stenosis, compression of hilar vessels and the presence of a pectus excavatum deformity. A single stage operative correction was performed with sternum repositioning by a Ravitch's procedure, pericardial fixation to the right sternal edge and obliteration of the left thoracic cavity with two silicone breast implants. All complaints disappeared within 48 h. DISCUSSION: To the best of our knowledge, this is the first report about successful treatment of PPS aggravated by a preexisting pectus excavatum in an adult patient. The durability and migration of the silicone implants and the volume reduction of the pericardial sac during fixation to the sternum continues to remain a concern. CONCLUSION: Single stage correction of PPS and pectus deformity is feasible and seems to be the appropriate treatment for both pathologies.