Delayed diagnosis of post-traumatic bronchial transection in a pediatric patient: A case report

Background

Tracheobronchial injuries (TBI) are rare yet potentially fatal complications of blunt chest trauma, often underdiagnosed due to nonspecific clinical manifestations.

Case presentation

We report the case of an 11-year-old Arab girl who developed progressive dyspnea two months after a motor vehicle accident initially managed conservatively. Imaging revealed complete atelectasis of the right lung and obstruction of the right main bronchus by granulation tissue. Bronchoscopy confirmed complete bronchial occlusion, and surgical intervention revealed a delayed bronchial transection. Successful end-to-end anastomosis restored full lung expansion and respiratory function.

Clinical discussion

This case highlights the diagnostic challenge of TBIs in children, particularly when symptoms present late. Anatomical vulnerability of the right bronchus, delayed symptom onset, and nonspecific radiologic signs may obscure early recognition. Granulation-induced bronchial obstruction, a known complication of undiagnosed TBIs, was confirmed intraoperatively.

Conclusion

Delayed presentation of tracheobronchial injury may lead to progressive airway obstruction due to granulation tissue. High suspicion, timely bronchoscopy, and early surgical intervention are essential to prevent irreversible lung damage and restore pulmonary function.