CASE PRESENTATION: A 60-year-old patient presented to the emergency room with cough, fever and shortness of breath. Chest radiograph identified a left lower lobe pneumonia. Pulmonary sepsis ensued, with hypotension and progressive respiratory failure. She was transferred to the ICU. After several failed attempts, she was intubated with a guidewire. A chest radiograph showed that the tube was located at the right main stem bronchus. Soon after repositioning of the tube, massive subcutaneous emphysema occurred. The hypothesis of a tracheal laceration was made and the patient was taken to the OR. We perrformed a cervicotomy, with longitudinal opening of the trachea. A 5 mm/30o scope was introduced, and a 6 cm full laceration of the membranous wall that extended to the right main bronchus was identified. It was repaired through the tracheotomy, with a running suture of polyglactin 4-0. A tracheostomy cannula was placed. Post-operative CT scan showed minimal emphysema, and no signs of disruption of the suture. At the 10th post-operative day, new pulmonary infiltrate ensued. The patient died at the 14th post-operative day. Post-mortem examination showed that the tracheal laceration was fully healed.