A PROXIMAL LEFT MAIN BRONCHIAL INJURY ; A MANAGEMENT DILEMMA

Tracheobronchial injuries are rare injuries that occur in less than 1% of patients following chest trauma. It should be considered in almost all patient presenting with blunt chest trauma. The diagnosis initially depends on careful history and physical examination in addition to high index of suspicion and accurate interpretation of radiological findings. The prompt recognition of the injury, skillful airway management and early treatment greatly reduce morbidity and increase the chances of restoring normal pulmonary function. In case of proximal left main bronchus injury ideally it should be exposed via a right posterolateral thoracotomy. This will provide a good exposure to the left main-stem bronchus and the carina compared to approaching it thorough a left posterolateral thoracotomy where the overlying aortic arch will obscure the field and makes it difficult to repair. We present a case of proximal left main bronchus injury that underwent left posterolateral thoracotomy repair with all difficulties because the left lung was lacerated and single lung isolation was not tolerated.