Pneumomediastinum secondary to iatrogenic tracheal rupture

Case contributed by Zach Hugh
Diagnosis certain


New subcutaneous emphysema following endotracheal intubation earlier in the day.

Patient Data

Age: 65 years old
Gender: Female

There is no pneumothorax. There is however pneumomediastinum and a double bronchial wall sign. This is associated with extensive subcutaneous emphysema involving the chest walls, axillae and supraclavicular fossae bilaterally.

Bilateral diffuse mixed airspace and interstitial changes are slightly worse compared to previous films (not shown).

The inflated balloon of the endotracheal tube causes posterior bulging of the membranous portion of the trachea. There is a defect in the posterior wall of the trachea adjacent to the tip of the endotracheal tube.

There is a significant volume of pneumomediastinum which extends superiorly into the deep spaces of the neck with extensive subcutaneous emphysema in the anterior chest wall.

Case Discussion

Extensive pneumomediastinum and subcutaneous emphysema resulting from iatrogenic tracheal perforation. At surgery, a 5 cm defect was found in the distal trachea.

Post-intubation tracheal rupture is a very rare complication, with incidence estimated at 0.05% to 0.37% of orotracheal intubations 1. Risk factors include anatomical tracheal abnormalities, chronic steroid use, and mediastinal pathologies that alter tracheal positioning, as well as health care provider inexperience and incorrect positioning of the endotracheal tube 1.

Case submitted by Dr. N. Larocque.

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