Pneumothorax and pneumoperitoneum after tracheostomy Vol. 62, No. 5, May 2012 Fig. 2. A portable chest radiograph (A) shows bilateral pneumothoraces, pneumomediastinum, pneumoperito- neum, and subcutaneous emphysema over both chest walls, neck, and shoul- der. Follow-up chest radiograph (B) after the left-sided closed thoracostomy revealed slight improvement in the pneumothorax. Fig. 3. Transverse and coronal CT images of the chest, abdomen, and pelvis. A large amount of the air is visible in the pleural cavity (A, C), mediastinum (A), peritoneal cavity (B, C), retroperitoneum (B) and subcutaneous tissue (B-D). These images show the passage of acciden- tally insufflated oxygen into multiple body compartments, which is a serious reminder of the potential complications of tracheostomy. The radiograph also showed both pneumomediastinum and CT scans of the chest, abdomen and pelvis were performed pneumoperitoneum. A thoracic surgeon was called to the for a further evaluation, revealing extensive subcutaneous bedside, where he inserted a chest tube into the left chest wall emphysema over the chest and abdominal walls, bilateral to treat the more extensive pneumothorax. After chest tube pneumothoraces, pneumomediastinum, massive pneumoperi- insertion, the patient’s vital signs became more stable, her toneum, and pneumoretroperitoneum (Fig. 3). An MRI of the mental status was alert, and she could follow verbal commands. brain was performed to evaluate the damage caused by the air The follow-up chest radiograph revealed improvement in the embolism but no specific abnormalities were found. Despite left-sided pneumothorax (Fig. 2B). The results of the arterial the extensive air distributed throughout the patient’s trunk, blood gas analysis performed 30 minutes after the chest tube the general and thoracic surgeons jointly decided to treat her insertion were as follows: pH 7.353, PaCO2 45.1 mmHg, PaO2 170.0 mmHg, HCO3- 24.7 mmol/L, SaO2 98.9%, and bicarbonate 1.0 mmol/L. conservatively. The patient was transferred to the ICU for careful moni- toring and supportive care where she remained for a week; 490 www.ekja.org