A neonate presented for an esophageal atresia repair and developed res
piratory distress in the immediate post-operative period. The initial
conventional chest radiographs suggested that there was a right sided
pneumothorax, however, this did not resolve, even after the placement
of two chest tubes. A CT examination suggested that the findings were
due to hyperinflation of the right upper lobe. Thoracoscopy was perfor
med and revealed a complex pneumothorax composed of bubbly mucous from
a post-operative pleuro-esophageal fistula.