Patterns in traumatic rupture of the bronchus

Some ruptures of the bronchus are diagnosed early but in many there is a long delay. This is because there are two distinct clinical patterns, one of which is not well recognized.In the first there is free communication between the bronchus and the pleura and the diagnosis is easily suspected when the lung fails to re-expand with adequate pleural suction.In the second there is little or no communication between the rupture site and the pleura. The peribronchial tissues maintain a conduit and ventilation of the lung continues until obstruction is produced by granulation tissue after a week or more. The lung then becomes airless and a mistaken diagnosis of retained secretions is easily made.The two types are illustrated by case reports.