PMC5224776_01
A view down the right main bronchus with part obliterated bronchi to lower and mid lobes as well as a tight upper lobe bronchus. A general inflammation was seen of the mucus membranes. The bronchoscopy was performed in the afternoon of ECMO day 1.
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ECMO ICU day 1: A bronchoscopy showed widespread general bronchial abnormalities such as mucosal edema, cobblestone mucosa, millimeter-sized yellowish granulomas, luminal narrowing of the bronchial tree, and almost complete stenotic parts on the right side (Fig. 1).
Two horizontal chest CT scan frames from the day of arrival to our ECMO ICU. The arrows indicate obliterations of the major airways. (A) indicates the draining ECMO cannula. The smaller cannula attached is the line of the Port-a-cath. The subcutaneous emphysema can be seen at top, but soft tissue emphysema has also dissected its way in the pectoral muscles.
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Airway obliterations/narrowings seen during bronchoscopy were confirmed (Fig. 2).
A frontal chest X-ray investigation from day 7. The patient has been tracheostomized, and the subcutaneous and mediastinal emphysemas as well as pneumothoraces are all reabsorbed. "White-out", water-soaked lungs, signs of pleural fluid, and/or larger atelectasis are evident bilaterally. At this point of the clinical course, the tidal volumes were 80 mL. Thus, the patient is virtually totally ECMO dependent.
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Figure 3 shows the chest X-ray from day after.
A frontal chest X-ray investigation 1 week after decannulation from ECMO. The right lower lobe lung necrosis is still persistent. The ECMO cannula has been removed, whilst the tracheal cannula and port-a-cath still are in place.
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All major chest radiology findings were of reversed, but for the right side basal necrotic mass (Fig. 4).