Diphtheria remains a significant cause of airway morbidity in under-immunized children. Emergency tracheostomy performed during the acute phase may lead to long-term complications such as tracheal stenosis, which poses major challenges during subsequent airway management. Iatrogenic pneumothorax is a rare but potentially fatal complication during emergency airway interventions. We report a case of a seven-year-old unvaccinated child with a history of diphtheria who underwent emergency tracheostomy followed by tracheoplasty for tracheal stenosis. Twenty days after decannulation, the child presented with acute respiratory failure due to post-tracheoplasty restenosis. Emergency airway management was attempted under spontaneous ventilation using inhalational anesthesia. Severe tracheal narrowing, scarring, and distorted anatomy resulted in difficult surgical access to the trachea. After securing the airway with a tracheostomy tube insertion, the child developed rapidly progressive subcutaneous emphysema and hemodynamic instability. Point-of-care lung ultrasound and chest radiography confirmed a large pneumothorax. Immediate needle thoracocentesis followed by chest tube insertion resulted in rapid clinical improvement. This case highlights the complexity of emergency airway management in children with post-diphtheria tracheal pathology. Early recognition of subcutaneous emphysema, prompt bedside imaging, and rapid intervention are critical to prevent catastrophic outcomes.
Prabha et al. (Wed,) studied this question.