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Endotracheal Tube Malfunction
Etiology: placed in patients who require ventilatory assistance
Imaging: endotracheal tube should usually lie over the right side of the spine and its tip should lie between the thoracic inlet and the carina, when the neck is in flexion the tip appears deeper than it really is and when the neck is in extension the tip appears higher than it really is, if the endotracheal tube lies over the left side of the spine and / or there is esophageal or gastric distension after intubation consider esophageal intubation
Complications: initial malposition or subsequent migration of endotracheal tube tip to a position above the thoracic inlet, initial malposition or subsequent migration of endotracheal tube tip to a position in the right mainstem bronchus causing atelectasis or pneumothorax, initial malposition of endotracheal tube tip into esophagus causing gastric distension
Treatment: further advancement of proximally placed endotracheal tube, retraction of distally placed endotracheal tube, replacement of endotracheal tube in esophagus
Clinical: presents as difficulty in ventilating the patient
Cases of Endotracheal Tube Malfunction
CXR AP shows the tip of the endotracheal tube to be between the clavicles and carina. The lungs are hypoinflated and there are symmetrical ground glass opacities present bilaterally.CXR AP shows the tip of the endotracheal tube to be above the thoracic inlet. The lungs are hyperinflated and there are coarse interstitial infiltrates bilaterally.CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the left upper lobe and left lower lobe and mediastinal shift to the left.CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the left upper lobe and left lower lobe but no mediastinal shift.CXR AP (above) shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with mediastinal shift to the left. CXR AP (below) was obtained after the endotracheal tube tip had been pulled back to an appropriate position between the clavicles and the carina with subsequent complete re-expansion of the left lung.CXR AP (above) shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with no mediastinal shift. CXR AP (below) was obtained after the endotracheal tube tip had been pulled back to an appropriate position just above the carina with subsequent near-complete re-expansion of the left lung.CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the right upper lobe with no mediastinal shift. There are diffuse ground glass opacities present throughout the lungs.CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is complete atelectasis of the left lung with no mediastinal shift. There is diffuse lucency in the right hemithorax which is also surrounding the right upper lobe.
CXR AP shows an endotracheal tube with its tip projecting over the left side of the spine with its tip beneath the carina. There is complete atelectasis of the left lung with mediastinal shift to the left. The stomach is massively distended with air.CXR AP (above) shows nasogastric tube with its tip within a distended stomach. An endotracheal tube is present to the right of the nasogastric tube and is projecting over an air-distended esophagus. There is near-complete atelectasis of the right lung. CXR AP (below) after reintubation now shows the endotracheal tube to the left of the nasogastric tube and interval resolution of the esophageal and gastric distension.CXR AP shows an endotracheal tube with its tip projecting beneath the carina and not over either mainstem bronchus and a distended stomach. There are diffuse ground glass opacities present throughout the lungs. CXR lateral shows the endotracheal tube to be posterior to the trachea and in the esophagus. CXR AP shows an endotracheal tube with its tip projecting beneath the carina and not over either mainstem bronchus and a distended stomach. CXR lateral shows the endotracheal tube to be posterior to the trachea and in the esophagus.
