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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Rapidly Progressive Subcutaneous Emphysema and Sequential Bilateral Pneumothoraces Following Pediatric
Dedric Bryant1, Ajay Pius2, Dominik Choromanski3
1Department of Anesthesiology, McLaren Greater Lansing, Lansing, USA.
Insights
Pediatric tracheocutaneous fistula closure can lead to air-leak complications like subcutaneous emphysema. Early recognition by anesthesia providers is crucial to prevent rapid progression to pneumothorax and respiratory compromise.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Thoracic Surgery
Background:
- Tracheocutaneous fistula (TCF) closure is a common procedure in children post-tracheostomy.
- While generally safe, postoperative air-leak complications such as subcutaneous emphysema, pneumomediastinum, and pneumothorax can occur.
Abstract:
Tracheocutaneous fistula (TCF) closure is commonly performed in pediatric patients following successful decannulation from long-term tracheostomy dependence. Although the procedure is generally considered safe, postoperative air-leak complications, including subcutaneous emphysema, pneumomediastinum, and pneumothorax, have been reported. Early recognition is critical because progression may lead to significant respiratory compromise. We report the case of a three-year-old child who developed rapidly progressive subcutaneous emphysema in the post-anesthesia care unit (PACU) following TCF closure after direct laryngoscopy and bronchoscopy. The patient subsequently developed massive subcutaneous emphysema that progressed to bilateral pneumothoraces requiring emergent chest tube placement and intensive care management. This case highlights the potential for rapid progression of postoperative air-leak syndromes following pediatric airway surgery and emphasizes the importance of early recognition by anesthesia providers during the immediate postoperative period. Awareness of the clinical presentation of subcutaneous emphysema and its potential progression to pneumomediastinum and pneumothorax is essential to prevent life-threatening complications.
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