Rupture of the right main bronchus: a case of a 4-year-old girl.

Tracheobronchial rupture after a blunt chest trauma is rare, especially in children. If the diagnosis is overlooked, severe ventilatory complications or mediastinitis may occur. We describe a case of a 4-year-old girl with a rupture of the right main bronchus after she was hit by a frame of steel (like a mini goal) that fell down while she was playing. The diagnosis was initially missed owing to a variety of symptoms. Difficulty with ventilation and persistent air leak after insertion of a chest tube in the case of a pneumothorax is suspect for a tracheobronchial rupture. This emphasizes once again the importance of the concept of rechecking and searching for the underlying cause when a pneumothorax persists. Bronchoscopy is the gold standard in establishing the diagnosis. Surgical treatment is in most cases the best option, especially in a ventilated patient. Without treatment mortality rates are up to 30%. In conclusion, tracheobronchial rupture should be excluded if mediastinal emphysema or a persistent air leak is present after a blunt thoracic trauma.