Presentation
Premature neonate. Respiratory distress and difficult ventilation.
Patient Data
The tip of the orogastric tube projects over the stomach bubble, well below the left hemidiaphragm.
The tip of the endotracheal tube projects over the T5/T6 intervertebral junction (normal ~T4), consistent with a right main bronchus intubation.
There is complete white-out of the left hemithorax with mediastinal shift to the left, reflecting a collapsed left lung.
The right lung is hyper-expanded, with intervening airspace consolidation and linear lucencies radiation out from the hilum. Lucencies reflect pulmonary interstitial emphysema.
Partially visualized bowel loops are gas filled and mildly distended.
Case Discussion
In this case, the neonate was extremely premature, only weighing 533g as per the x-ray annotation. The right main bronchus intubation lead to underventilation of the left lung (which collapsed) and overventilation of the right lung.
Overventilation lead to pulmonary interstitial emphysema on the right - linear lucencies radiating out from the right hilum as air tracks through the interstitium of the bronchovascular bundles. This would have occurred as a result of barotrauma.
The neonate was being managed for respiratory distress syndrome, which accounted for the background increased airspace opacification in the right lung.
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