A 32 year-old male with no previous medical problems, other than a history of smoking cigarettes, was infected by swine-origin influenza virus (SOIV) and developed severe ‘FLAAARDS’ (‘flu’-A associated acute respiratory distress syndrome) requiring treatment with ECMO (extra-corporeal membrane oxygenation).
His chest and abdominal radiographs are shown.
Chest radiograph: swine flu and ECMO
Abdominal radiograph: swine flu and ECMO
Q1. Describe the findings on the chest and abdominal radiographs.
The clinically relevant findings on these radiographs include:
- tracheostomy.
- confluent lung opacities bilaterally consistent with severe “FLAAARDS” requiring venoarterial ECMO.
- There are 3 ECMO cannulae – there is a left carotid artery cannula returning blood to the aorta, and two drainage cannulae in the inferior vena cava accessed via the left and right femoral veins.
- right internal jugular vein vascath appropriately positioned.
- a nasogastric tube with the tip sited in the stomach.
- a ‘Tiger tube’ (a type of jejunal feeding tube) that has failed to pass through the pylorus – it has looped around and the tip is adjacent to the tip of the nasogastric tube. The Tiger tube has distinctive flanges that grip the gastrointestinal mucosa so that it advanced as a result of peristalsis.
- a faecally loaded colon.
If haven’t got your ‘swine flu’ vaccine yet, maybe these images will provide you with the incentive to get your act together!
About Chris Nickson
Did you change the first x-ray ? it seems the one that was on display 2 days ago didn’t have a tracheostomy tube but rather some kind of ET tube that was selectively intubating the right main bronchus… Must have been dreaming…
Did you change the first x-ray ? it seems the one that was on display 2 days ago didn’t have a tracheostomy tube but rather some kind of ET tube that was selectively intubating the right main bronchus… Must have been dreaming…
Did you change the first x-ray ? it seems the one that was on display 2 days ago didn’t have a tracheostomy tube but rather some kind of ET tube that was selectively intubating the right main bronchus… Must have been dreaming…
Did you change the first x-ray ? it seems the one that was on display 2 days ago didn’t have a tracheostomy tube but rather some kind of ET tube that was selectively intubating the left main bronchus… Must have been dreaming…
Did you change the first x-ray ? it seems the one that was on display 2 days ago didn’t have a tracheostomy tube but rather some kind of ET tube that was selectively intubating the left main bronchus… Must have been dreaming…
Did you change the first x-ray ? it seems the one that was on display 2 days ago didn’t have a tracheostomy tube but rather some kind of ET tube that was selectively intubating the left main bronchus… Must have been dreaming…
Very observant Matthias! I realised I put up a different CXR to the one I initially intended…
I couldn’t leave the other up because I still haven’t been able to figure out what exactly that tube in the left main bronchus was all about! It might have been an exchange catheter -- I will aim to put it back up once I’ve confirmed what it was (wasn’t during my shift).
Thanks Chris, good to know that my sanity is not lost ! I was also wondering about this piece of equipment intubating the LMB, because it looked quite small and radio-opaque for an ET tube. Thanks for your great cases by the way.
Thanks Chris, good to know that my sanity is not lost ! I was also wondering about this piece of equipment intubating the LMB, because it looked quite small and radio-opaque for an ET tube. Thanks for your great cases by the way.
Thanks Chris, good to know that my sanity is not lost ! I was also wondering about this piece of equipment intubating the LMB, because it looked quite small and radio-opaque for an ET tube. Thanks for your great cases by the way.
Main airway luminogram ,air bronchogram and alveolar airspace are not seen.Thoracic ultrasonography and BFC are mandatory ruling out bronchial obstruction and massive pleural effusion.Pulmonnary edema is also possible.The two neck catheters are displaced to the right sugesting lateral transmediastinal pressure.Is the left neck catheter in a left vena cava,or in artherial or mediastinal position?.The diffuse left medial and inferior air shadow must be investigated.Cannulae are too close and inferior promoting recirculation if VvA or Vv ECMO.