Late Post-Intubation Pneumomediastinum and Cervical Emphysema

Authors: M. Waloszková 1;  R. Salzman 1;  R. Uher 2;  P. Chrapková 1;  I. Stárek 1
Authors‘ workplace: Otolaryngologická klinika LF UP a FN Olomouc ;  přednosta prof. MUDr. I. Stárek, CSc. Klinika anesteziologie, resuscitace a intenzivní medicíny FN Olomouc 1;  přednosta doc. MUDr. M. Adamus, Ph. D. 2
Published in: Otorinolaryng. a Foniat. /Prague/, 62, 2013, No. 3, pp. 132-135.
Category: Case History


Post-intubation pneumomediastinum and subcutaneous emphysema of the neck is a recognized complication of endotracheal tube insertion. This rare complication requires surgeon’s attention as it could result in a life-threatening condition. The air usually leaks firstly to mediastinum and then to the subcutaneous tissues of the neck through laceration in tracheal mucosa. The growing emphysema of the neck usually manifests straight after faulty intubation or shortly after extubation in cases when endotracheal tube cuff sealed the tracheal wall defect. The diagnosis is confirmed by the CT examination, which reveals an air in mediastinum and soft tissues of the neck. In large defects planned for surgical repair, bronchoscopy is the method of choice for precise localization and description of the extent of the tracheal mucosal defect. The therapy is determined by the extent of the tear and clinical state of patient.

Authors present a rare case of late postintubation pneumomediastinum and subcutaneous emphysema of the neck. The delayed manifestation was probably caused by primarily non-penetrative intubation injury. The area of weakened tracheal wall probably ruptured as a result of increased intrathoracic pressure during the cough or defecation. The discussion covers etiology, diagnostics as well as treatment suggestions of this iatrogenic complication.

pneumomediastinum, subcutaneous emphysema, intubation, tracheal laceration


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Audiology Paediatric ENT ENT (Otorhinolaryngology)
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