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Tracheal rupture is a rare but serious complication after endotracheal intubation.

We report the case of an 85-years-old female patient presenting a massive skin emphysema after endotracheal emergency intubation. A CT-scan of the thorax showed a massive mediastinal emphysema and a dislocated tube cuff in the pleural cavity. The implemented bronchoscopy also showed the suspicion for tracheal rupture.

A double-lumen-tube-intubation failed due to a trapped tube cuff, which could not be extracted.  In the following emergency surgery, the transthoracic intubation of the left main bronchus was the lifesaving procedure. Afterwards a successful tracheal reconstruction was made. 

When tracheal rupture occurs early detection and an accurate treatment is necessary.