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Radiology Image: Ventilation problem?

Ventilation problem?

[headline_subtitle title=”” subtitle=”Can you solve the radiology image of this edition?”]
Presentation

X-thorax of a 50-year old female after an incident of near drowning. After an easy intubation, her oxygen saturation increased significantly, but still remained low (<90%).

X-Thorax

Question about the X-Thorax.

M. Nazir & M. Hollmann

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a) Due to aspiration of water

This is not the correct answer. The patient indeed aspirated water, which is visible as bilateral consolidations on the X-ray. For this reason she was intubated. However, after intubation SpO2 increased, suggesting an increase in oxygenation and thereby making this less likely to be the cause of her suboptimal oxygen saturation.

b) Because of atelectasis due to near drowning

This is not the correct answer. Atelectasis arises amongst other reasons when the lung is being compressed, usually depending on position or a mechanical obstruction. In this case obstruction can be caused by the presence of aspirated water. Yet, by intubating the patient this lung area is likely to be recruited, making atelectasis as the cause of this clinical scenario less likely.

c) The tube is inserted too deep

This is the correct answer. Placement of the tube too deep is the most likely cause of the low saturation. As you can see on the X-thorax, the tube passes the carina and is inserted in the right bronchus. Pulling back the tube a few centimetre (2 cm) will increase the ventilation of the right lung and thereby increase SpO2 in general.

d) Due to a non-pulmonary cause

This is not the correct answer. This might be also the case, yet you first have to exclude all other possible problems in the Airway or Breathing when you do an ABCD. The A is supposed to be secured by placement of a tube but in this case it has blocked a part of the airway (right lung).

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