Presentation
Increase work of breathing in mechanical ventilation
Patient Data
Right upper lobe opacification with volume loss in keeping with right upper lobe atelectasis.
ET tube tip is just above carina.
Left upper limb PICC tip over right atrium.
NG tube tip in stomach.
ET tube tip has been withdrawn compared to previous.
Resolution of right upper lobe atelectasis.
Bronchovascular prominence persists.
Case Discussion
Right upper lobe collapse is not uncommon in neonates who have been intubated. The position of the tube on the x-ray is not always the position of the tube during intubation and so, a tube tip that is a little low on the film may have been in the right main bronchus distal to the RUL bronchus during the procedure resulting in RUL collapse.
Similar findings can be seen in neonates with infection although the right upper lobe would be an unusual location.
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