Rapid Fire Radiology

The Iatrogenic Foreign Body

Department of Emergency Medicine

Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10555
 Optimal ETT Tube Positioning

• 5 ± 2 cm above the carina

• When the carina cannot be visualized the ideal position of
ETT is in the middle third of trachea at T2 to T4 level
 Complications

• insertion into bronchus (pneumonia/pulmonary

contusion/pulmonary laceration)
• pharyngeal or esophageal perforation
Case courtesy of Dr Muneesh Sharma, Radiopaedia.org, rID: 10328
Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 56505
 Optimal Central Line Positioning

Cavo-Atrial Junction:

yellow arrow: two vertebral body levels

below the level of the carina

blue arrow: intersection of bronchus

intermedius with superior right heart
border

red arrow: intersection of the superior

right heart border with SVC contour
 Complications

• insertion into right atrium or ventricle

(non-bacterial thrombotic
endocarditis / dysrhythmias /
myocardial perforation)
• mediastinal hematoma secondary to
vessel perforation
• pneumothorax
• hemothorax
• central line-associated bloodstream
infection
• deep venous thrombosis
Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 29298
Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 43483
Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 21694
Optimal Nasogastric Tube Positioning

Ideally, 10 cm beyond the gastroesophageal junction.

Post-Pyloric Tubes

Crosses Midline!!!
 Complications

• insertion into trachea or bronchus (pneumonia/pulmonary contusion/pulmonary

laceration)
• pharyngeal or esophageal perforation
Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 8904
 Chest Tube Positioning
• intercostal tube tip lies between
visceral and parietal pleura
• anterosuperiorly to drain
pneumothorax
• posteroinferiorly to drain
pleural effusion or hemothorax

Complications:
• placement into lung parenchyma,
interlobar fissure or subcutaneous
tissue
• mediastinal or abdominal visceral
trauma
• re-expansion pulmonary edema
 Pacemakers/AICD

• single chamber: electrode tip in

right atrial appendage (atrial
pacing) or right ventricular apex
(ventricular pacing)
• dual chamber: electrode tips in
right atrium and right ventricular
apex
• biventricular: electrode tips in right
atrium, right ventricle and coronary
sinus
• implantable converter defibrillator:
electrode tip in apex of right
ventricle
 Complications

• lead malposition (dysrhythmias)

• pneumothorax
• myocardial perforation
• lead fracture
Guess the Device!!!
Case courtesy of Dr Hein Els, Radiopaedia.org, rID: 30776
BONUS