Malposition – ChestDB.com

Case 30

ICU/Surgery, Lines/Tubes/Devices / Age 31-60, IABP, Intra-Aortic Balloon Pump, Malposition, Peripherally Inserted Central Catheter, PICC, Portable, Pulmonary Edema, Swan-Ganz Catheter

This radiograph demonstrates a misplaced right IJ Swan-Ganz catheter. Not only is the catheter too deep in the right pulmonary artery, the course of the catheter extends all the way into the abdominal IVC before looping back into the right atrium and crossing the tricuspid valve. Other lines and devices include a left upper extremity PICC with the tip terminating in the SVC, and an intra-aortic balloon pump (IABP) with the distal marker appropriately located just inferior to the aortic knob.

The cardiac silhouette is prominent and there is mild interstitial edema, which makes sense in the context of an IABP indicating that the patient is in heart failure.

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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, Midline Sternotomy, Portable, Sternotomy, Watchman

This radiograph shows a malpositioned enteric tube which is looped in the oropharynx/hypopharynx and projects over the lower neck. There are a number of incidental findings including an appropriately positioned endotracheal tube, a loop recorder projecting over the left hemithorax, sternotomy wires with a prosthetic aortic valve, and a Watchman™ left atrial appendage occlusion device which is difficult to see on the default window and level. Linear subsegmental atelectasis is seen 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 shows 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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Case 14

Lines/Tubes/Devices / Age >61, Azygous Vein, Malposition, Peripherally Inserted Central Catheter, PICC, Portable

This radiograph shows a malpositioned left upper extremity PICC (peripherally inserted central catheter). The catheter takes an unexpected superior turn after entering the superior vena cava and is beginning to course medially, consistent with placement in the azygous vein. A lateral radiograph would provide further confirmation if available, but in this case the location can be confidently deduced with just an AP view. The study is otherwise unremarkable.

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