Misplaced tubes

Case contributed by RMH Core Conditions

Presentation

Multi-trauma.

Patient Data

Age: Unknown
Gender: Male

Chest

Modality: X-ray

ETT is virtually at the level of the carina and should be withdrawn. Nasogastric tube is in the stomach. Left intercostal catheter at tip is against the mediastinum and left Pneumocath tip is projected over the heart. Small bilateral pneumothoraces are present together with multiple bilateral rib fractures. No right sided intercostal catheter is seen. Elevated left hemidiaphragm. 

Modality: CT

The left sided pneumocath passes through the inferior aspect of the pulmonary outflow tract, over the left coronary artery and the tip passes into the left atrium. There are locules of gas in the left subclavian vein and brachiocephalic vein. The left ICC is not clearly in the pleural space. While it may run in an accessory fissure, the tip lies against the mediastinum and the distal 7cm is occluded. Small left pneumothorax. The right ICC terminates in the soft tissue in the right upper thorax, and is not in the pleural space.  The tip of the ETT is 1cm from the carina. 

Moderate right pneumothorax. No thoracic aortic injury. Patchy right middle lobe and lower lobe and left lingula airspace consolidation. Patchy right upper lobe ground glass opacification. Right subcutaneous emphysema. Extends into the pretracheal and right carotid facial spaces. Multiple rib fractures bilaterally. Right: 1st posterior,anterior and lateral are comminuted; 2nd posterior (comminuted), lateral (comminuted) and anterior; 3rd posterior (displaced), lateral (displaced) and anterior; 4th posterior (displaced and comminuted), lateral (displaced); 5th posterior (displaced and comminuted), and lateral (displaced); 6th posterior and lateral (mildly displaced); 7th lateral (comminuted and displaced); 8th posterolateral. Left: 1st lateral (displaced); 2nd lateral; 3rd anterolateral; 4th lateral; 5th anterolateral; 6th anterolateral; 7th anterior. Minimally displaced fracture of the right clavicle at the junction of the mid and distal thirds. No sternal fracture.

Case Discussion

Following lines are misplaced:

  • left pneumocath passes into the pulmonary outflow tract and left atrium as in close proximity to the left coronary artery
  • right ICC is not intra-thoracic
  • left ICC appears intraparenchymal
  • ETT is within 1cm of the carina 
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Case Information

rID: 27926
Case created: 27th Feb 2014
Last edited: 30th Jan 2016
System: Chest
Inclusion in quiz mode: Included

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