Bilateral tension pneumothorax during pediatric bronchoscopy (high-frequency jet injection ventilation)

Bilateral tension pneumothorax complicating high-frequency jet injection ventilation during rigid open bronchoscopy for foreign body removal in a 3-year-old child is reported. Subcutaneous emphysema, bradycardia and low voltage of the QRS complex were the presenting symptoms. Disparition of heart dullness by percussion was the most suggestive clinical sign while auscultation of the breath sounds was not conclusive. It is stressed that tension pneumothorax is a potential life-threatening complication of high-frequency injection ventilation and should be promptly considered in any case of persistent cardiac deterioration during pediatric bronchoscopy.