Is Diagnosis Up in the Air?

ANSWER

The radiograph shows 3 abnormalities:

(1) The endotracheal tube is in the right mainstem bronchus—a finding that in part leads to

(2) A whiteout of the left lung; the latter is due partly to collapse and atelectasis and partly to a possible pneumothorax.

(3) There is evidence of free air under the left hemidiaphragm, which is concerning for an intra-abdominal injury, such as a perforated viscus.

The patient’s endotracheal tube was partially withdrawn, and a left chest tube was placed. Subsequent CT of the abdomen confirmed the finding of free air. She was then taken to the operating room for an emergent laparotomy.