Bronchial rupture by a double-lumen endobronchial tube during staging thoracoscopy

Single-lung ventilation using a double-lumen endobronchial tube (EBT) is often performed for surgical procedures involving the thorax. The ability to isolate and collapse the nondependent lung is particularly imperative for thoracoscopic procedures, because adequate visualization of most intrathoracic structures depends on near complete atelectasis. Despite proper placement and use of an EBT, severe airway injury by the tube tip or either of its cuffs may occur occasionally. Previous reports seem to be limited to injury during open thoracotomy, in which broad visual exposure of the entire thorax is possible. We report a case of iatrogenic bronchial rupture during the use of an EBT for staging thoracoscopy in which the site of injury was not appreciated initially during the videoscopic examination.