A Crunch in the ER - Case Report

A 33yr old male presented with extensive subcutaneous emphysema with hoarseness of voice following a road accident. Patient was haemodynamically stable with no clinical evidence of rib fractures or pneumothorax. Trauma protocol was followed which suggested no intracranial or bony involvement but, MSCT neck and thorax suggested a significant pneumomediastinum extending superiorly into the deep spaces of neck bilaterally with subcutaneous emphysema in the anterior chest wall. Narrowing of the trachea with thickening of the posterior tracheal wall at C7-T1 level-possible tracheal rent at T1 level. Air leak was suspected likely at the level of C6-C7.