A rare case of spontaneous tracheal perforation

Description

A 25-year-old man presented with spontaneous surgical emphysema resulting in swelling of his upper torso, neck and face. He had an allogeneic bone marrow transplant (BMT) 1 year earlier for acute myeloid leukaemia, complicated by severe refractory chronic graft-versus-host disease (GVHD). The CT thorax demonstrated a tracheal defect causing pneumomediastinum, marked surgical emphysema and features of atypical pulmonary infection (figure 1). The flexible bronchoscopy confirmed the presence of two anterior perforations in the cervical trachea (figure 2). No samples were taken for microscopy as the patient desaturated during bronchoscopy and the procedure was abandoned.

Figure 1

CT thorax shows a defect in the anterior wall of the trachea causing pneumomediastinum and marked surgical emphysema. The lungs show patchy areas of ground-glass opacification suspicious of an atypical infection.

Figure 2

Bronchoscopy reveals two perforations in the anterior tracheal...

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