The Occurrence of Extensive Subcutaneous Emphysema and Pneumothorax After Endotracheal Tube Removal: A Case Report

Both pneumothorax and subcutaneous emphysema (SCE) after extubation are very rare. Pneumothorax occurs due to lung structure rupture, whereas SCE develops if an air leak persists. In this case report, we describe a patient with stone aspiration who developed severe SCE and pneumothorax after extubation. The patient was a 5-year-old Iranian boy of Baluch ethnicity who had accidentally aspirated a stone. The otolaryngologist attempted removal via bronchoscopy but was unsuccessful and ordered the patient’s transfer to a better-equipped center. We attempted to extubate the patient before his transfer; however, after the endotracheal tube was removed, he developed severe SCE. As a result, we had to re-intubate the patient and place him on mechanical ventilation. Pneumothorax is an underappreciated complication of foreign body aspiration (FBA) that can occur even in the absence of high-pressure ventilation. The timing of pneumothorax development can be unpredictable, and clinicians should maintain a high level of suspicion for quick diagnosis and treatment.