PMC4381825_01
Series of the chest x-rays of the patient. Initial radiograph upon presentation showed bilateral infiltrates (1A). Post intubation x-ray shows endotracheal tube in the right main stem bronchus (1B). After repositioning the endotracheal tube, there is the progression of the bilateral infiltrations (1C). Post ECMO cannulation at arrival to our facility, there is a large loculated pneumothorax in the left thorax (1D).. ECMO = extracorporeal membrane oxygenation.
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F001
In the emergency department, she rapidly developed acute hypoxic respiratory failure with bilateral infiltrates on chest x-ray (Figure 1A). Post-intubation chest x-ray showed the endotracheal tube in the right main stem bronchus (Figure 1B), requiring adjustment (Figure 1C). PEEP 10 for lung protection. Peak airway pressure and mean airway pressure remained elevated (58 cm H2O and 15 cm H2O respectively). Post-ECMO chest x-ray showed a loculated lower left pneumothorax, treated immediately with bedside thoracostomy tube placement (Figure 1D).
Bronchoscopy confirms membranous defect 1 cm above the carina.
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F002
Axial (A) and sagittal (B) computed tomography images demonstrating 3-4 cm defect in posterior membranous trachea (arrow).
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