• Morgan Le Guen, Catherine Beigelman, Belaid Bouhemad, Yang Wenjïe, Frederic Marmion, and Jean-Jacques Rouby.
• Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie Paris-6, France. morgan.le-guen@psl.aphp.fr
• Crit Care. 2007 Jan 1; 11 (5): R94.

IntroductionUnnoticed bronchial injury during the early stage of resuscitation of multiple trauma is not rare and increases mortality and morbidity.MethodsThree-dimensional reconstruction of the airways using a workstation connected to a multidetector chest computed tomography (CT) scanner may change the diagnostic strategy in patients with blunt chest trauma with clinical signs evocative of bronchial rupture.ResultsIn this case report of a young motor biker, a complete disruption of the intermediary trunk was first misdiagnosed using standard chest helical CT and bronchoscopy. Postprocessing procedures including three-dimensional extraction of the tracheobronchial tree were determinants for establishing the diagnosis, and emergent surgical repair was successfully performed. Follow-up using CT with three-dimensional reconstructions evidenced a bronchial stenosis located at the site of the rupture.ConclusionThe present study demonstrates the potential interest of performing three-dimensional reconstructions by extraction of the tracheal-bronchial tree in patients with severe blunt chest trauma suspected of bronchial rupture.

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