The radiological features of tracheal rupture following endotracheal intubation

We present a case study of a 30 year old female patient who experienced excessive retching and vomiting. This occurred after receiving oral fluids 5h after receiving general anaesthetic for an elective orthopaedic surgical procedure (open reduction and internal fixation for a right proximal radial fracture). The pre-procedure chest radiograph prior to surgery was normal. A chest radiograph performed 6 hours after extubation showed significant subcutaneous emphysema within the neck and upper chest, as well as pneumomediastinum. There was no evidence of oesophageal rupture on water-soluble contrast swallow. Multislice CT chest confirmed the presence of subcutaneous emphysema in the neck and chest and pneumomediastinum. Tracheal rupture was also demonstrated on CT and confirmed on flexible bronchoscopy. The patient had conservative management. Repeat flexible bronchoscopy approximately two weeks later showed healing of the tracheal tear. Repeat chest radiograph, two weeks later, showed no residual pneumomediastinum and almost complete resolution of the subcutaneous emphysema.