Double lumen endotracheal tube

Case contributed by Dr Balint Botz


Esophagectomy and gastric pull-up performed on the same day earlier. CXR requested to assess position of central venous catheter, chest drains, and endotracheal tube.

Patient Data

Age: 75 years
Gender: Male

Portable, supine AP CXR


Upon first glance the endotracheal tube (ETT) seems to be in a poor position, advanced well into the left main bronchus. However after more close scrutiny the contour of a second tube can be discerned, which terminates in the trachea (see key image). The requesting physician was contacted, who verified that indeed, a double lumen ETT was inserted, for which this is the satisfactory position with a bronchial lumen ending in the left main bronchus, and a separate tracheal lumen ventilating the right lung. 

Other: right thoracotomy, chest drains, right jugular central venous catheter in a correct position, subcutaneous emphysema on the right, moderate pleural effusion on the left. 

Annotated image

Key image showing the position of the tip of the tracheal tube (arrow) and its relation to the carina (line measurement). 

Case Discussion

Double lumen endotracheal tubes are more difficult to assess, as the tracheal tube is easily obscured. Therefore, if the type of tube is not known to the reader, it is very easy to arrive at the wrong conclusion and describe an ETT malpositioning.

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