Chest X-ray - Tubes
ET Tubes - Complications

Key points

  • Intubation of a bronchus may lead to lung or lobar collapse
  • Accidental intubation of a bronchus is more common on the right

If inserted too far, an endotracheal tube (ET tube) can enter the right or left main bronchus. This results in ventilation of a single lung and can result in collapse of the contralateral lung or a lobe of the intubated lung.

Accidental intubation of a bronchus is more common on the right because the right main bronchus is more vertically orientated than the left main bronchus.

ET tube misplaced at carina

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

ET tube misplaced at carina

  • This ET tube tip is incorrectly located at the level of the carina and nearly enters the right main bronchus
  • Although both lungs are currently ventilated there is a risk of intubation of a single bronchus on neck movement
  • This tube should be repositioned by a trained individual

ET tube misplaced in right main bronchus

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

ET tube misplaced in right main bronchus

  • The ET tube has entered the right main bronchus
  • This tube should be repositioned by a trained individual

ET tube misplacement with lung collapse

Intubation of a bronchus may result in collapse of the contralateral lung.

Misplaced ET tube with lung collapse

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Misplaced ET tube with lung collapse

  • The ET tube is within the right main bronchus
  • The tube and its cuff occlude the orifice of the left main bronchus which is not visible
  • Consequently the left lung is not ventilated and has collapsed

Barotrauma

Complications of mechanical ventilation such as pneumothorax, pneumomediastinum and surgical emphysema may be visible on a chest X-ray.

Pneumomediastinum and surgical emphysema

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Pneumomediastinum and surgical emphysema

  • The ET tube tip is adequately positioned, 5 cm above the carina
  • Surgical emphysema is readily visible in the soft tissues of the neck on the right
  • Pneumomediastinum (gas in the soft tissues of the mediastinum) is often more difficult to identify
  • In this image the mediastinum is outlined by a thin white line (arrowheads)
  • This line is the mediastinal pleura which is separated from the mediastinum by gas
  • These are the typical appearances of pneumomediastinum

Oesophageal intubation

Oesophageal intubation may be a fatal complication and should be detected clinically before a patient is sent for a chest X-ray.