Barotrauma due to mechanical ventilation

Case contributed by Dr David Cuete

Presentation

Respiratory impairment after mechanical ventilation.

Patient Data

Age: 60 years
Gender: Female
CT

CT Chest

Computed tomography demonstrated bilateral pneumothorax, pneumomediastinum, extensive subcutaneous emphysema in cervical regions and anterior chest wall. There is also pneumoperitoneum. There is right pleural effusion and areas of higher density in the lung parenchyma corresponding to pneumonic foci. Endotracheal tube well located.

Case Discussion

In this case these appearances are typical of barotrauma. Barotrauma occurs between 4 and 15% of all patients undergoing mechanical ventilation.

Pulmonary barotrauma is the alveolar rupture due to the use of positive pressure. Clinical manifestations of barotrauma are multiple interstitial emphysema, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, tension lung cysts and subpleural air cysts. As noted, all these forms of barotrauma are developed by a ruptured alveolus, overdistended with penetration of air into the perivascular interstitium  or interstitial emphysema.

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Case information

rID: 28079
Case created: 8th Mar 2014
Last edited: 26th Oct 2017
System: Chest
Inclusion in quiz mode: Included

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