Tracheal bronchial injury (TBI) is an uncommon event after blunt thoracic trauma, especially in the pediatric age group. No reports of a delayed bronchial repair after treatment with low dose steroids were found in the literature. Also, no reports of a sleeve resection at this age for trauma were found. Therefore, we were prompted to report on an eight year old female with delayed diagnosis of traumatic bronchial injury subsequently treated with steroids prior to definitive surgical repair.
An 8 year old girl suffered from blunt chest trauma with a distal left main bronchus injury diagnosed by flexible bronchoscopy 10 days out from initial injury. The child was then treated with a short course of low dose steroids followed by a sleeve resection and primary anastamosis of the distal bronchus Now, two and a half years out, the patient is doing well with no respiratory difficulties, a normal CXR, and is actively participating in sporting events.DISCUSSION: The initial delay in the diagnosis, as well as the clinical stability of the patient, led to the consideration of using low dose steroids in an attempt to limit the scarring and possible stenosis of the involved bronchus. Also, the site of injury was in the distal left main bronchus just at the bifurcation and the possibility of a pneumonectomy, during an early surgical repair of inflamed tissues, persuaded us to delay the repair. We felt that a course of low dose steroids could provide decreased inflammation and scarring at the periphery of the injury; therefore, allowing resection of less bronchus.
We conclude that a sleeve resection for trauma can be done successfully in the pediatric population. Also, we believe that in selected cases of TBI, a short course of low dose steroids can reduce the inflammation related to trauma, allows some healing, and reduces the amount of bronchus to be resected.
H.A. Kirk, None.