Acute bronchial obstruction arising from an endobronchial blood clot and confused as a pneumothorax: a case report

A 67-year-old woman underwent craniotomy and clipping of anterior communicating artery aneurysm. On the tenth postoperative day, she underwent tracheostomy uneventfully. On the fortieth postoperative day, sudden massive bleeding occurred around the tracheostomy site. After orotracheal intubation was performed to explore the tracheostomy site, desaturation and increase in airway pressure occurred. On the physical examinations, this situation looked like a pneumothorax. However, chest radiography revealed a hyperinflation at the affected lung. Flexible bronchoscopy at bedside revealed a large blood clot obstructing the left main bronchus. Ipsilateral lung hyperinflation resulted from the blood clot that acted as one-way valve in the bronchus. Airway obstruction like this situation can be confused as a tension pneumothorax.