CTICasesIatrogenic Tracheal Rupture from Endotracheal Tube Balloon Overinflation
Imaging findings
Chest radiograph and CT show extensive subcutaneous emphysema, severe pneumomediastinum, and a right-sided chest tube positioned directly through the lung parenchyma with surrounding pulmonary hemorrhage. On chest CT, there is a focal, 3 cm outpouching of the posterior membranous trachea at the level of the inflated endotracheal tube cuff, appearing similar to a vascular pseudoaneurysm. This finding was absent on the pre-intubation CT.
Key takeaways
Tracheal rupture is a rare but life-threatening mechanical complication of endotracheal intubation, most commonly involving the posterior membranous trachea. The injury can result from mechanical trauma during tube insertion or from overinflation of the cuff balloon, particularly when patient movement or coughing occurs. Rapid identification of a focal tracheal outpouching or worsening pneumomediastinum on CT should prompt urgent bronchoscopic evaluation and surgical repair.
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