Tracheomediastinal emphysema after tracheostomy in a post-COVID-19 patient: a case report

M. Bicakcioglu, S. Demircan, A. Yucel, A.B. Ozer

Department of Anesthesiology and Intensive Care, Inonu University Medical School, Malatya, Turkey. abelinozer@gmail.com

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• Anesthesiology
• Infectious Diseases

OBJECTIVE: There are no reports of tracheomediastinal fistula development after tracheostomy.

CASE REPORT: A 72-year-old female patient with post acute COVID-19 was transferred to our intensive care unit. After two unsuccessful weaning attempts, a tracheostomy was performed at hospitalization on day 32. The patient’s body mass index was 35 kg/m2 and she had a narrow neck anatomy. A percutaneous tracheostomy was performed using the Griggs method without any problems. Pneumothorax, pneumomediastinum, subcutaneous emphysema, and hemorrhage were not observed. Twenty-two days after the tracheostomy, the patient developed subcutaneous emphysema and experienced a sudden decrease in oxygen saturation. Bedside anterior-posterior chest X-ray did not detect pneumothorax and a tracheoesophageal fistula was found via esophageal endoscopy. A tracheomediastinal fistula was observed just below the cannula distal end via computed tomography.

CONCLUSIONS: There are multiple reasons why a tracheomediastinal fistula could develop after tracheostomy. Therefore, this condition should be considered in cases of sudden subcutaneous emphysema and oxygen deterioration following tracheostomy.

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