Enteric Tube – ChestDB.com

Case 36

ICU/Surgery, Infectious/Inflammatory, Lines/Tubes/Devices / Age <30, Central Venous Catheter, CVC, Empyema, Endotracheal Tube, Enteric Tube, Nodule (Cavitary), Pleural Effusion, Portable, Septic Embolism

This radiograph demonstrates typical findings of septic emboli. There are multiple bilateral nodules, many with cavitation. Metastatic disease would be within the differential for this finding, though in practice the clinical history is typically quite useful to distinguish between these two entities; In this case, the patient is young with a history of drug abuse (suggesting endocarditis as a source) and presents with sepsis. In addition, this patient has medium bilateral pleural effusions. In the setting of septic emboli this is concerning for empyema. CT is usually confirmatory.

Support devices include a central venous catheter in the right internal jugular vein, an endotracheal tube in the mid trachea, and an enteric tube entering the stomach and terminating inferiorly beyond the border of the study.

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Case 19

ICU/Surgery, Lines/Tubes/Devices / Age <30, Enteric Tube, NAVA, Neonatal Respiratory Distress Syndrome, Neurally Adjusted Ventilatory Assist, PIE, Portable, Premature Neonate, Pulmonary Interstitial Emphysema, RDS (Neonatal), Surfactant Deficiency Disorder

This radiograph is of a premature infant in the first week of life. The right lung demonstrates diffuse microatelectasis typical of Neonatal Respiratory Distress Syndrome (RDS), also known as Surfactant Deficiency Disorder, caused by insufficient surfactant production in the setting of prematurity (typically <35 weeks gestation). The left lung is hyperinflated relative to the right lung, with diffuse linear lucencies radiating from the hilum. This appearance is typical for Pulmonary Interstitial Emphysema (PIE), a condition secondary to barotrauma from ventilation seen in premature infants in the first weeks of life. An NG/OG tube terminates in the body of the stomach. A second tube, thicker and denser than the NG/OG, with multiple rounded lucencies along the distal aspect is also seen. This is a NAVA tube (Neurally Adjusted Ventilatory Assist), which detects electrical activity of the diaphragm to improve synchrony with the ventilator.

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Case 18

Emergency & Trauma, Infectious/Inflammatory / Age <30, Aspiration, Consolidation, Endotracheal Tube, Enteric Tube, Esophageal Temperature Probe, Fracture, Portable

This radiograph demonstrates obvious consolidation in the right lower lung field, with more subtle retrocardiac left lower lobe consolidation. There is a displaced left mid-clavicular fracture. Lines and tubes include an endotracheal tube, an enteric tube, and an esophageal temperature probe. Without additional history, the lung findings are not specific. The distribution is typical for aspiration, though infection is also high on the differential. Contusion is also a consideration in a trauma patient. In this case, the EMS report included witnessed aspiration which makes it the likely etiology.

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Case 16

ICU/Surgery, Lines/Tubes/Devices / Age >61, Aortic Valve Replacement, Atelectasis (Compressive/Passive), Endotracheal Tube, Enteric Tube, Left Atrial Appendage Closure Device, Loop Recorder, Malposition, Portable, Watchman

This radiograph demonstrates a malpositioned enteric tube which is looped in the oropharynx/hypopharynx. There are a number of incidental findings including an appropriately positioned endotracheal tube, a loop recorder projecting over the left chest wall, postsurgical changes of sternotomy with a prosthetic aortic valve, and a Watchman left atrial appendage occlusion device which is difficult to see on the default window and level. The lung volumes are low overall with some linear subsegmental atelectasis in the left lung base.

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Case 15

ICU/Surgery, Lines/Tubes/Devices / Age <30, Atelectasis (Lung), Bronchial Intubation, Endotracheal Tube, Enteric Tube, Malposition, Portable

This radiograph demonstrates a malpositioned endotracheal tube in the right main bronchus with resultant atelectasis of the entire left lung. The heart is shifted toward the left side. This supports the diagnosis of atelectasis over a large pleural effusion, which would look similar except that the heart would shift to the contralateral side. An enteric tube is also seen entering the stomach and terminating inferiorly beyond the border of the study. EKG wires, bra clasps, and bra underwires are seen externally.

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