This endotracheal tube was inserted through the trachea and paratracheal soft tissues into the thoracic cavity during resuscitation.
This is a view of the chest wall of an 18-month-old toddler with a history of tracheomalacia and subaortic stenosis who required a tracheostomy. During a bout of crying, the tracheostomy tube became dislodged, and after nurses attempted to reposition it, the baby rapidly developed subcutaneous emphysema, followed by bilateral tension pneumothoraces. Autopsy demonstrated marked subcutaneous emphysema, including periorbital swelling. The tube had been removed before the autopsy, precluding assessment of its placement. This particular view demonstrates air bubbles within the subcutaneous fat. It is important that all tubes remain in the body for objective postmortem (autopsy) evaluation of their placement.