Where is the Tube

Radiology Esophageal Intubation

Fig. 14.3 The tip of the tube is located in the right mainstem bronchus! The left lung is increased in density owing to atelectasis and has lost volume; the mediastinum is displaced to the left. The stomach is significantly overdistended as a consequence of a previous esophageal intubation, which has since been corrected. During the accident or during intubation, the patient has aspirated a dental filling. There is another extremely important finding visible on this radiograph. Do you see it?

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I Pneumothorax a Pneumothorax a Pneumothorax

Apical Pneumothorax

b Apical pneumothorax c "Deep sulcus sign"

b Apical pneumothorax c "Deep sulcus sign"

Apical Pneumothorax

Fig. 14.4a The pleural margin appears as a fine line running along the right thoracic wall that is not traversed by any vessels. A tension pneumothorax is not yet present. To prevent its development, an intrathoracic tube may need to be inserted. b In another patient, only a fine line is visible apically between the third and fourth ribs dorsally (arrow). If you are not absolutely sure,

Fig. 14.4a The pleural margin appears as a fine line running along the right thoracic wall that is not traversed by any vessels. A tension pneumothorax is not yet present. To prevent its development, an intrathoracic tube may need to be inserted. b In another patient, only a fine line is visible apically between the third and fourth ribs dorsally (arrow). If you are not absolutely sure, you can have the radiograph repeated in expiration. This technique often makes the air-filled pleural space wider and better visible. c Paravertebrally on the left you see the pointed deep pleural recess, also called "deep sulcus sign." The partially airless left lower lobe is seen reaching into it but not filling it. A chest tube has already been inserted in this patient.

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