title: Tracheal rupture resulting in life-threatening subcutaneous emphysema.
abstract: We present a case of a patient with severe chronic obstructive pulmonary disease who developed dramatic mediastinal and subcutaneous emphysema, without pneumothorax, following a difficult intubation. Misdiagnosis of tracheal rupture as barotrauma from alveolar overdistention initially delayed intervention and caused persistence of subcutaneous emphysema. Despite efforts to minimize tidal volume and airway pressure, the large airway disruption and positive-pressure ventilation resulted in tension subcutaneous emphysema with near-fatal hemodynamic compromise, oliguria, and respiratory acidosis. Decompression with subcutaneous vents immediately reversed the life-threatening circulatory and respiratory compromise and stabilized the patient until surgical correction of the tracheal tear could be accomplished.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, WA 98104, USA.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Gries
authors.forename: David J
authors.initials: DJ
authors.lastname: Pierson
mesh_terms: D001469:Barotrauma / Q000175:diagnosis*; D001999:Bronchoscopy; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012121:Respiration, Artificial; D012421:Rupture; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging / Q000293:injuries*