case_images: PMC6535340_01
case_images: (
  A
  ) Clinical appearance of the patient in the trauma bay after intubation and bilateral needle thoracostomy; (
  B
  ) computed tomography imaging displaying rupture of the right main stem bronchus (arrow), massive soft tissue and mediastinal emphysema, and significant right pneumothorax and in spite of drainage (*thoracostomy tube).
case_images: 10-1055-s-0039-1681038-i180418cr-1.jpg
case_images: PMC6535340_01_10-1055-s-0039-1681038-i180418cr-1.jpg
case_images: FI180418cr-1
case_images: Still, there was no obvious difference in breath sounds on both sides, so bilateral needle thoracostomy was performed, and the patient was endotracheally intubated ( Fig. 1A ). Computed tomography (CT) scan showed a complete avulsion of the right main stem bronchus at the level of the carina, a residual pneumothorax with mediastinal shifting, atelectasis of the right lung, as well as emphysema of the mediastinum and soft tissue ( Fig. 1B ).
case_images: Intraoperative placement of traction suture at the caudal tracheal rim of the defect, allowing simultaneous occlusion of the defect and patency of the left main stem bronchus.
case_images: 10-1055-s-0039-1681038-i180418cr-2.jpg
case_images: PMC6535340_01_10-1055-s-0039-1681038-i180418cr-2.jpg
case_images: FI180418cr-2
case_images: Hence, intubation under visual and tactile guidance with a preloaded 5.0 tube, using bronchoscope as "guidewire," was possible ( Fig. 2 ).