Presentation
Recovering from multi-trauma. Now breathless.
Patient Data
Complete white out of the left hemithorax.
When compared to the baseline position of the trachea, the trachea on this study is deviated to the left. Furthermore, there is evidence of posterior rib crowding on the left. The right lung and pleural space are clear. Assessment of the cardiomediastinal contours is limited by the left hemithorax opacification. NGT remains in situ. Bilateral rib fractures.
Patient went on to have a bronchoscopy. This CXR was obtained 4 hours after the first xray.
The ETT and NGT remain in situ. There is improvement in the appearance of airspace opacity within the left lower lobe, with only patchy change persisting within the medial aspect of the left lower zone. The left pleural effusion has resolved. Allowing for projection, the cardiomediastinal contours are within normal limits. Bilateral rib fractures.
The nasogastric tube has been repositioned with the tip now although not visualised appearing to lie below the level of the diaphragm. Left lower lobe consolidation and left pleural effusion are unchanged in appearance. The right lung remains clear. The patient is slightly rotated to the left, however allowing for this the cardiomediastinal contours appear stable. Bilateral displaced rib fractures.
Case Discussion
Mucus plugging can lead to dramatic collapse and is a common cause of respiratory decline in intubated patients. Rapid recognition and bronchoscopy and lead to equally rapid improvement.
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