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A case of mediastinal hemorrhage along with hemorrhage into a pneumatocele while on extracorporeal membrane oxygenation (ECMO) is presented. Computerized tomography of the chest was utilized to support the diagnosis. Barotrauma to the lungs best explains the inciting event that allowed the hemorrhage to occur once the patient was heparinized for ECMO. This complication serves to point out the importance of commencing early ECMO support before widespread pulmonary and mediastinal barotrauma develops.
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