Post-traumatic bronchial mucus plug leading to pneumonectomy

Abstract

Background : Blunt trauma of the chest is not uncommon these days. By far, the most important cause of significant blunt chest trauma is motor vehicle accidents. Pedestrians struck by vehicles, falls from height, blast injuries and acts of violence are other causative mechanisms. Most of the blunt trauma cases need no operative intervention and can be managed by supportive procedures. Aim : We present a case of a 10-year old boy who had blunt trauma to chest due to fall from height. Findings : The patient was in respiratory distress and developed surgical emphysema and pneumothorax on the left side. He was managed by putting in a chest drain on the left side. Patient improved and was discharged .He again developed respiratory distress 15 days later. On bronchoscopic examination, an obstruction was found just distal to the carina in the left bronchus. Several futile attempts were made to retrieve the obstructing material. Hence, mucus plug was removed through left bronchotomy. There was no improvement in the ventilation of the left lung for 7 days. Bronchoscopic suction was done. All the measures failed and the lung remained collapsed. Patient underwent pneumonectomy as the last treatment option available in our hospital. At the time of reporting this case, patient was doing well. Conclusion : Chest physiotherapy helps in reducing lung collapse. If patient is reluctant to chest physiotherapy and coughing, it can lead to accumulation of respiratory secretions and formation of mucus plug. This mucus plug can cause collapse of the lung and ill consequences. Keywords : Trauma, atelectasis, pneumonectomy, bronchotomy, mucus plug