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Case of the Week 293 
What's the most likely diagnosis?
- Close-up of chest radiograph following intubation of a 29 year-old in motor vehicle collision
- Fracture of the right 6th rib
- Pneumomediastinum
- Right lower lobe atelectasis
- Pneumothorax
- Difficult intubation
Additional Image-CT of chest done at same time
Additional Image
CT of Chest displayed at "bone" window
Answer:
5. Difficult intubation (tooth in the right lower lobe bronchus)
More (Click Discussion Tab)
Traumatic Intubation (Tooth in Right lower Lobe Bronchus)
General Considerations
- With difficult intubation, practitioner tends to increase lifting forces of laryngoscope blade
- May lead to damage of intraoral tissues and osseous structures
- Dental injuries associated with intubation
- Maxillary central incisors are at most risk
- Fifty percent of dental trauma from intubation happens during laryngoscopy itself
- 23% occurs following extubation
- Dental injuries are more common in
- Small children
- Patients with periodontal disease or fixed dental work
- Patients in whom intubation is difficult
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LearningRadiology.com is an award-winning educational site aimed primarily at medical students and radiology residents-in-training, containing lectures, handouts, images, Cases of the Week, archives of case quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, cardiac, and bone radiology.
