A six-month-old female with a history of recurrent bronchopulmonary infections was admitted to the Montreal Children's Hospital in severe respiratory distress. Cardiac arrest ensued and although ventilation by mask was always possible during the resuscitation procedure, there was a confusing inability to aerate the lungs after successful intubation. A right-sided tracheal diverticulum was identified at autopsy. It was assumed, in retrospect, that the intubating tube entered and abutted against the wall of the diverticulum, thus obstructing its distal lumen. The embryology, morphology and pathophysiology of congenital tracheal diverticuli are discussed. This rare diagnosis should be entertained when successful intubation leads to ineffectual ventilation
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