Forklift-Induced Thoracic Trauma with Bronchial Rupture: A Survival Case Report in a Referral Center

Abstract

Tracheobronchial injuries are rare but potentially fatal events, usually associated with high-energy chest trauma and often diagnosed late. Proper airway management is essential for survival in such cases. This report describes the case of a 34-year-old man who sustained thoracic crush trauma after being struck by a forklift, presenting with a penetrating wound to the right hemithorax, subcutaneous emphysema, and severe respiratory failure. He was intubated in the prehospital setting and transferred by air to a trauma referral center. Upon admission, he exhibited hemodynamic instability and refractory hypoxemia, prompting immediate transfer to the operating room. During the procedure, a complete transection of the trachea approximately 3 cm above the carina was identified, associated with extensive laceration of the right main bronchus. It was noted that the patient had been selectively intubated into the left bronchus, which unintentionally allowed effective ventilation of the left lung, maintaining minimal oxygenation until surgical repair. A tracheobronchial anastomosis was performed, followed by vascular evaluation that revealed vertebral artery dissection. The patient progressed with respiratory stability but developed sequelae, including posterior circulation ischemic stroke, partial visual deficit, tracheal stenosis, and motor-sensory impairment of the right upper limb. This case highlights the importance of early recognition of tracheobronchial injuries, appropriate airway management, and timely transfer to specialized centers. The accidental left main bronchus intubation played a crucial role in survival, serving as a temporarily protective ventilation strategy in the setting of complete tracheal rupture.