Lung Compartment Syndrome Resulting from Bronchial Laceration and Traumatic Hemo-Pneumatocele
Jacquelyn Brandenburg, DO, ZoŽ Jones, MD, Jess D. Schwartz, MD.
University of New Mexico, Albuquerque, NM, USA.
Objective: Intrathoracic compartment syndromes are rare. We present the first reported case of lung compartment syndrome due to traumatic bleeding into a hemo-pneumatocele.
Methods: A 21-year-old male, survivor of a motor vehicle accident, presented with a tension hemo-pneumothorax and was found on CT scan to have multiple intra-abdominal/thoracic injuries including left main-stem bronchial injury and a small left upper lobe hemo-pneumatocele. At thoracotomy we identified a circumferentially avulsed left main-stem bronchus which was repair primarily in an end-to-end fashion and covered with an intercostal muscle flap. The hemo-pneumatocele was left untouched. Over the next 9 days consolidation of the left lung did not improve despite positive-pressure ventilation and multiple bronchoscopies. A CT angiogram demonstrated complete left upper lobe consolidation with loss of lobar pulmonary artery blood flow. At re-do thoracotomy we found a massive hemo-pneumatocele within the left upper lobe obscuring the hilum of the lung. After decompression of the hemo-pneumatocele the left upper lobe was found to be completely thrombosed and a left upper lobectomy was performed.
Results: Three months later he was discharged in stable condition and at six months was found to have a left main-stem bronchial stricture treated with endobronchial balloon dilatation. At two years post discharge the patient remained asymptomatic and a CT scan demonstrated a healthy appearing left lower lobe of the lung.
Conclusion: This case highlights the rare presentation and successful management of ischemic thoracic compartment syndrome of the left upper lobe of the lung secondary to ongoing bleeding into a traumatic hemo-pneumatocele.
Back to 2019 Program