Minimally invasive treatment of retrocardiac tension pneumomediastinum in an extremely low birth weight infant

A 23.4-week premature and extremely low birth weight neonate was transferred to the Neonatal Intensive Care Unit for management of respiratory failure and retrocardiac pneumomediastinum, suspected to be the result of a low tracheal injury during intubation. Initial conservative management failed and chest radiographs demonstrated worsening retrocardiac pneumomediastinum. Due to the patient’s extreme low birth weight and location of the pneumomediastinum, surgery was deemed to be very high risk and potentially fatal. We report the successful definitive percutaneous management of retrocardiac tension pneumomediastinum with a minimally invasive bedside method using an intercostal paraspinal approach under the guidance of ultrasound and plain radiography.