Bubbly intrapleural mucous simulating congenital lobar emphysema

A neonate presented for an esophageal atresia repair and developed respiratory distress in the immediate post-operative period. The initial conventional chest radiographs suggested that there was a right sided pneumothorax; however, this did not resolve, even after the placement of two chest tubes. A CT examination suggested that the findings were due to hyperinflation of the right upper lobe. Thoracoscopy was performed and revealed a complex pneumothorax composed of bubbly mucous from a post-operative pleuro-esophageal fistula.