Initial Misdiagnosis as a Tracheal Laceration: What happens in case of an Endotracheal Tube Cuff Over-Insufflation?

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Tansel Günendi
Osman Hakan Kocaman
Mustafa Erman Dörterler
Osman Dere
Mehmet Emin Boleken

Abstract

Trauma is one of the main causes of death and disability in children. Dependent on the severity of the trauma, the first intervention of pediatric trauma patients takes place at the trauma site and then they are transferred to a trauma center. In the meantime, due to the complications that may arise, necessary precautions should be taken quickly.


An eleven-year-old boy was brought to our hospital with the pre diagnosis of chest blunt trauma caused by a car collision. During preliminary evaluation, chest X-ray and computed tomography revealed a sphere radiolucency that initially suggested a pneumomediastinum due to tracheal laceration. But after careful inspection, it was understood to be an endotracheal tube cuff over-insufflation.


Endotracheal intubation is one of the first interventions that may be performed in emergency conditions, as well as being an elective intervention in operating theatre. Intubations performed in the trauma-scene, in the ambulance or operation room, where patient’s vital signs are in jeopardy -such as traffic accident or firearm injury- mistakes may arise and the end of the tube may not always go to the right place. It can end up in the esophagus or, thanks to its anatomical inclination, tip of the tube could easily be directed to the right main bronchus. In very rare cases, iatrogenic injuries can be encountered.


Our case of overinflated endotracheal tube cuff is a good example of how a simple intubation maneuver can expose us to a highly morbid clinical condition such as tracheal rupture or pneumomediastinum.

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Case Report