We report for the first time on the delayed repair of a distal bronchial injury (BI) in a child, treated with steroids prior to definitive surgical repair.
An 8 year old child, run over by a truck, developed a left sided tension pneumothorax treated with a chest tube. Ten days later she was transferred to us for atelectasis of the left lung. The initial air leak had resolved and a flexible bronchoscopy showed bronchial disruption of the very distal left main stem bronchus. We planned a delayed repair considering that the injury in the distal left main bronchus carried a high risk of pneumonectomy during an early surgical repair for possible friability of the bronchial biforcation. She was discharged on low dose steroids and after 2 weeks a limited sleeve resection of the distal left main stem bronchus was performed through the left 4th intercostal space . Four years later, she is doing well and has a normal CXR.
In children the incidence of BI is very rare due to the elasticity of the tissues. Most injuries occur in the proximity of the carina. It was the initial delay in the diagnosis, as well as the clinical stability of the patient, that led us to the consideration of using low dose steroids in an attempt to limit the inflammation and stenosis of the involved bronchus. Whether or not the use of low dose steroids contributed to less scarring and a successful repair cannot be stated from a single case and should be further investigated.
We conclude that in selected cases of BI, a short course of low dose steroids can reduce the inflammation related to trauma, allow some healing, and possibly reduce the amount of scarring.
The option of using a short course of low dose steroids when presented with a late diagnosis of tracheobronchial injury should be considered.
Alden Kirk, None.