Massive Subcutaneous Emphysema and Pneumomediastinum Following Endotracheal Intubation

Akihiro Sakamoto, Youichirou Kogou, Nobuhiro Matsumoto, Masamitsu Nakazato
2013 Internal medicine (Tokyo. 1992)  
A 66-year-old woman with subclinical pulmonary tuberculosis sequelae was admitted to our hospital due to fever, coughing and dyspnea. She underwent immediate oral intubation with an endotracheal tube and was placed on a ventilator due to severe hypoxia. Several hours after intubation, extensive swelling developed in the cervical region and anterior chest wall. Chest computed tomography revealed massive subcutaneous emphysema and a pneumomediastinum (Picture). We treated the patient
more » ... atient conservatively, and the emphysema completely resolved several days later. She was diagnosed with pneumocystis pneumonia that was considered to have been the cause of her presenting symptoms. After treatment, she was discharged uneventfully. Subcutaneous emphysema with a pneumomediastinum is a common clinical manifestation of rare tracheal injury fol-lowing intubation (1). Repeated attempts to perform a difficult intubation, allegedly one of the most common factors contributing to postintubation tracheal injury (2), was considered to be the possible cause of injury in the present case. The authors state that they have no Conflict of Interest (COI). References 1. Medina CR, Camargo Jde J, Felicetti JC, Machuca TN, Gomes Bde M, Melo IA. Post-intubation tracheal injury: report of three cases and literature review. J Bras Pneumol 35: 809-813, 2009. 2. Conti M, Pougeoise M, Wurtz A, et al. Management of postintubation tracheobronchial ruptures. Chest 130: 412-418, 2006.
doi:10.2169/internalmedicine.52.0575 pmid:23903518 fatcat:qwfzoyoqjbfzlk5ggy3663cgte