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Postoperative lordoscoliosis causing extrinsic compression of the right main stem bronchus and respiratory insufficiency.
The thoracic esophagus extends from the suprasternal notch to the diaphragmatic hiatus, passing posterior to the trachea, the tracheal bifurcation, and the left main stem bronchus.
Re-evaluation by bronchoscopy and echocardiography revealed a normal left main stem bronchus, a normal left pulmonary artery and a closed ductus arteriosus.
This clinical scenario suggests that transient pulmonary hypertension may result in significant airway compression due to the proximity of the left main stem bronchus to the left pulmonary artery.
Fig. 1 Chest X-ray revealed nasogastric tube inserted into right main stem bronchus.
In Augusta, USA, ultrasound capture of the lung-sliding sign in a cadaver had been found to be accurate in detecting ETT placement in the trachea, oesophagus and right main stem bronchus.
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The ratio between left main-stem bronchus diameter on CT imaging and outer tracheal diameter measured with US was 0.68.
A high sensitivity (95 100 %) was found for detection of oesophageal versus airway (trachea or right main-stem bronchus) intubation.
The ratio between the diameter of the trachea and of the left main-stem bronchus was obtained by examining the CT images of a series of patients.
If there is bilateral lung sliding, it is confirmation that the tube is in the airway, but intubation of a main-stem bronchus cannot be ruled out.
However, when the technique is used to distinguish between main-stem bronchus versus tracheal intubation, chest radiography is better than diaphragmatic ultrasound [70].
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