Kosin Med J.  2019 Dec;34(2):161-167. 10.7180/kmj.2019.34.2.161.

Iatrogenic Tension Pneumothorax after Surgical Tracheostomy in a Child with Idiopathic Subglottic Stenosis: case report

• Park SY
• Yim WJ
• Jeong JH
• Kim J
• Lee SC
• Choi SR
• Lee JH
• Chung CJ

• KMID: 2467977
• DOI: http://doi.org/10.7180/kmj.2019.34.2.161

Abstract

Tracheostomy is increasingly performed in children for upper airway anomalies. Here, an 18-month-old child (height 84.1 cm, weight 12.5 kg) presented to the emergency department with dyspnea, stridor, and chest retraction. However, exploration of the airways using a bronchoscope failed due to subglottic stenosis. Therefore, a surgical tracheostomy was successfully performed with manual mask ventilation. However, pneumomediastinum was found in the postoperative chest radiograph. Although an oxygen saturation of 99% was initially maintained, oxygen saturation levels dropped, due to sudden dyspnea, after 3 hours. A chest radiograph taken at this time revealed a left tension pneumothorax and small right pneumothorax. Despite a needle thoracostomy, the pneumothorax was aggravated, and cardiac arrest occurred. Cardiopulmonary-cerebral resuscitation was performed, but the patient was declared dead 30 minutes later. This study highlights the fatal complications that can occur in children during tracheostomy. Therefore, close monitoring, immediate suspicion, recognition, and aggressive management may avoid fatal outcomes.

Keyword

Pediatrics; Pneumomediastinum; Tension pneumothorax; Tracheostomy; Thoracostomy

MeSH Terms

Bronchoscopes
Child*
Constriction, Pathologic*
Dyspnea
Emergency Service, Hospital
Fatal Outcome
Heart Arrest
Humans
Infant
Masks
Mediastinal Emphysema
Oxygen
Pediatrics
Pneumothorax*
Radiography, Thoracic
Respiratory Sounds
Resuscitation
Thoracostomy
Thorax
Tracheostomy*
Ventilation
Oxygen

Figure

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  Fig. 1 Bronchoscopic view of subglottic stenosis

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  Fig. 2 A chest radiograph showing the pneumomediastinum(arrows) after tracheostomy

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  Fig. 3 A chest radiograph showing the pneumomediastinum(arrow heads), the right pneumothorax and left tension pneumothorax(black arrows)

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  Fig. 4 A chest radiograph showing the pneumomediastinum(arrow heads) and the bilateral pneumothorax(black arrows)

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