Watch out! The ET tube is malpositioned into the right mainstem bronchus. This emergency required us to call the ER doctors because removal and repositioning of the ET tube is warranted.
Observation
Clinical History: s/p cardiac arrest.
Technique: DX chest, portable 1 view
ET tube with its tip in the right mainstem bronchus. Suggest retraction by about 5 cm. There is marked cardiomegaly. Opacities are noted bilaterally more on the suprahilar and perihilar regions with air-bronchograms. Followup with PA and lateral chest radiograph is recommended.
Impression
APPARENT MALPOSITION OF ET TUBE, AS DESCRIBED. SUGGEST RETRACTION BY ABOUT 5 CM. MARKED CARDIOMEGALY. FINDINGS IN THE LUNGS POSSIBLY DUE TO PULMONARY EDEMA OR PNEUMONIA. RECOMMEND FOLLOW-UP.
This case shows laterally dislocated 2nd through 5th metatarsal bones relative to the tarsals and suggests a Lisfranc dislocation, named after Jacques Lisfranc, who, as a field surgeon in Napoleon’s army, described an innovative technique to amputate the forefoot of soldiers as a means to treat frostbite. Of the two basic types, our patient appears to have the Homolateral type, wherein all the metatarsals are dislocated to one side.
Further reading:
http://emedicine.medscape.com/article/1236228-overview
Observation
Clinical History: Pain, swelling, ankle and foot fractures
Technique: DX left foot (3 views)
Compared with prior study dated February 2, 2010 (21:03)
The presence of cast material obscures subtle bony detail, limiting the study. At least three well corticated osseous structures posterior to the talus are again seen, unchanged. Partly imaged fractures of the medial and lateral malleolus show no significant interval change and are described in detail in the accompanying ankle films. The mineralization of the visualized bony structures is well maintained. Soft tissue swelling around the ankle joint is again seen and appears unchanged. Compared to the pre-reduction film, a lateral displacement of the second through fifth metatarsals and possibly also of the first metatarsal in relation to the tarsal bones, is now more apparent.
Impression
INTERVAL PLACEMENT OF CAST. LATERAL DISPLACEMENT OF THE SECOND THROUGH FIFTH METATARSALS IN RELATION TO THE TARSAL BONES, AND PROBABLY OF THE FIRST METATARSAL IS NOW MORE APPARENT, SUGGESTIVE OF A LISFRANC DISLOCATION. FURTHER EVALUATION WITH MRI MAY BE OF BENEFIT. OTHERWISE STABLE STUDY OF THE LEFT FOOT.
Today’s case is a rare condition where there is transposition of a loop of large intestine (usually transverse colon/hepatic flexure of the colon) in between the right diaphragm and the liver, as seen in on plain abdominal X-ray or chest X-ray. It is said that this seen in only about 0.1-1.0% of chest x-rays.
Observation
Clinical History: Pre-op
Technique: DX chest 2 views
The cardiomediastinal silhouette appears to be within normal limits. The lungs are hyperexpanded with flatteing of the hemidiaphragms. No acute focal infiltrate or consolidation is seen. There is presence of an air-filled bowel loop, between the liver and right hemidiaphragm, which is usually of no clinical significance.
Impression
CLEAR CHEST. CONSIDER COPD. OTHER FINDINGS AS NOTED ABOVE.
