VACTERL association is typically defined by the presence of at least three of the congenital malformations that make up the term including: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula (TEF), renal anomalies, and limb deformities. Patients with VACTERL are typically managed through immediate-postnatal-surgical correction of the specific congenital anomalies (typically anal atresia, specific types of cardiac malformations, and/or TEF), followed by long-term medical management of the congenital malformations. Although congenital anomalies might have long-lasting effects, the prognosis can be positive when the best surgical remedy is possible. Here, we present a case of 5 years female that is a known case of VACTERL Status Post (S/P)TEF repair, S/P double outlet right ventricle repair at sixth day and fifth month of life. This child managed to survive despite being operated in a resource-limited setting.

Pneumomediastinum (PM) and Subcutaneous emphysema (SCE) following foreign body aspiration is very rare. Pneumomediastinum (PM) occurs due to alveolar rupture whereas subcutaneous emphysema occurs if air leak persists. It is benign in nature but in some cases, it might be fatal. Therefore, proper assessment and management is required to limit the life-threatening complications and FB should always be suspected whenever spontaneous PM and SCE is seen. We describe an 18-month-old boy who was presented with cough, fever and respiratory distress to Siddhi Memorial Hospital (for women and children), Emergency Department. On examination, there was decreased air entry over supra-mammary and infra-axillary region on left side of the lung field. He had foreign body in left distal bronchus with PM and SCE with in radiography. The patient was treated with oxygen, antibiotics and planned for bronchoscopy but the child self-expectorated bean seed while coughing. PM and SCE are very rare presentations of foreign body aspiration in children of age less than 3 years and in such circumstances, the possibility of foreign body should be considered.