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ment of 2 self-fixing screws that were connected with a longitudinal bar into the vertebral bodies of T5 and T7. The operation was through a right posterolateral thoracotomy, and the operative report made no mention of any encounters with the bronchial system. However, an early postoperative chest x-ray film and a computed tomographic (CT) scan showed a dislocation of the T5 screw and proximity between the prosthetic connecting bar and the right main bronchus. She was discharged from the hospital after an apparently smooth postoperative course, and 6 months later, she had resumed full physical activity, including parachuting. Twelve months after the operation, she was readmitted with coughing that was triggered by deep breathing and bronchospastic attacks, which were treated with corticosteroids and β-mimetic puffers. She had progressive loss of strength that led to physical inactivity. On admission to our intensive care unit, thoracic CT (Fig 1) and examination with a rigid bronchoscope (Fig 2) showed a perforated pars membranacea starting at the carinal origin of the right main bronchus and extending to the distal aspect of the bronchus intermedius. The findings were compatible with damage that had been caused by the proximal screw and the longitudinal bar of the internal fixation prosthesis. There were no clinical signs of active pleural or mediastinal infection, but there was a small infiltrate in the ventral segment of the right upper lobe. Endoscopically, no active bleeding was found, but the CT scan showed that the azygos vein was in close proximity to the head of the T5 screw, and the point of the screw abutted the lateral wall of the descending aorta. These findings, together with the history of recurrent hemoptysis, were considered an emergency indication to remove the internal fixation prosthesis. An iterative posteroIatrogenic tracheobronchial injuries most often are tears that result from endotracheal intubation, diagnostic or operative endoscopies, long-term ventilatory support or barotraumas, or injury during procedures adjacent to the trachea (eg, mediastinoscopy or esophagectomy). Such tears usually are partial or complete disruptions that are immediately recognized, and thus effective surgical therapy provides excellent functional outcomes. We describe a delayed bronchial sleeve resection of an iatrogenic laceration of the membranous wall of the right bronchial tree with reanastomosis between the middle-lower lobe carina and main bronchus takeoff and reimplantation of the upper lobe bronchus into the distal, ventral, intrathoracic trachea. Clinical summary. A 31-year-old woman presented with recurrent severe hemoptysis after having had coughing and bronchospastic attacks for 1.5 years. Her history revealed that a posttraumatic fracture of the T6 vertebral body had been stabilized 2.5 years previously by means of transpleural placeTRACHEAL REIMPLANTATION OF THE RIGHT UPPER LOBE BRONCHUS WITH SLEEVE MAIN AND INTERMEDIUS BRONCHUS RESECTION AND RECONSTRUCTION

Tracheal reimplantation of the right upper lobe bronchus with sleeve main and intermedius bronchus resection and reconstruction