Question
What is the most likely diagnosis?
| A. |
Pleural Effusion |
| B. |
Hypoplastic Left Lung Syndrome |
| C. |
Misplaced ETT |
| D. |
Misplaced Nasogastric Tube |
Show Answer
|
Correct Answer � C Explanation |
 |
Ans:C.)Misplaced ETT
Image shows:Atelectasis, Left Lung. Tip of endotracheal tube (red arrow) projects below the carina (blue arrow) into the bronchus intermedius on the right.
Complications of Endotracheal Tube
Imaging Findings – Malposition
- Most often malpositioned in right mainstem bronchus because of shallower angle right main bronchus makes with trachea than does left mainstem bronchus
- Right mainstem bronchus intubation will lead to atelectasis of entire left lung and hyperinflation right lung
- Bronchus intermedius intubation may lead to atelectasis of entire left lung and the right upper lobe
- ETT tip in the neck may lead to vocal cord injury
- Also may lead to perforation of the pyriform sinus, larynx or trachea and pneumomediastinum, subcutaneous emphysema, pneumothorax
- Esophageal intubation may be suspected if tube deviates from the tracheal air shadow and there is a dilated esophagus and stomach
Other Complications
Aspiration/pneumonia
- Dependent portions of lungs
- Lower lobes
Foreign body aspiration
- Broken teeth
- Dentures
- Fillings
Pneumothorax, pulmonary interstitial emphysema, pneumomediastinum from barotrauma
- Rupture of alveoli from high pressures with mechanical ventilation
Sinusitis from prolonged nasotracheal intubation
Long-term Sequelae
- More common with tracheostomy tubes than endotracheal tubes
- Laryngeal injury from scarring of posterior glottis, fusion posterior commissure, arytenoid injury, subglottic stenosis
- Tracheal stenosis
- Tracheomalacia
- Fistulae to esophagus, adjacent blood vessels
