Respiratory distress syndrome and malpositioned ET tube
27-week gestation neonate. Respiratory distress. Intubated.
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Bilateral granular appearance to both lungs. Increased opacification on the left secondary to a malpositioned ETT tube in the right main bronchus.
Always deal with lines and tubes first. Don't miss an ET tube down the right main bronchus. The background lung parenchyma has the characteristic appearance of respiratory distress syndrome (RDS).
Even without the history of the gestation of the patient, lack of humeral head ossification and the size and shape of the thorax should push you towards an early preterm infant.