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Tracheobronchial Injury — FRCA Final MCQ

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HardTrauma & Emergency AnaesthesiaTracheobronchial InjuryFRCA Final

A 28-year-old man (ASA I) sustains isolated bilateral pneumothoraces from a high-speed car crash. He has bilateral chest drains inserted. After 5 days, the right drain stops bubbling and the lung is fully expanded on CXR. The left drain continues to bubble persistently. What is the most likely cause of the persistent air leak?

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Correct answer: D — Blocked drain

Persistent air leak (>5-7 days) following traumatic pneumothorax suggests tracheobronchial injury (tear of a main bronchus or trachea). In high-speed deceleration injuries, the right main bronchus (within 2.5 cm of the carina) is most commonly injured. Bronchoscopy is required for diagnosis. Management depends on the location and size of the tear: small tears may heal conservatively, while large tears or complete disruptions require surgical repair. Persistent pneumothorax with continuous air leak despite adequate chest drainage should always raise suspicion for bronchial injury.

Reference: ATLS – 2018 – 10th edition; NICE – 2023 – NG39 Major trauma