See Case 2. The CXR shows that the endotracheal tube is too far down and the tip is now sitting at the origin of the right main-stem bronchus. The ideal position is for the tip of the tube to be at the level of the clavicles. This patient also had a right central venous catheter inserted. The tip of the central venous catheter should ideally lie at the junction of the superior vena cava and the right atrium. The other important finding is that of a lucent area at the anterior costophrenic recess on the right side with no lung markings. This is the deep sulcus sign and is indicative of a right pneumothorax (Fig. 60.2). In addition, the right hemidiaphragm is depressed and the mediastinum shifted away indicating a tension pneumothorax.
Case 61. This middle-aged male was diagnosed as having asthma but has not improved following inhaled steroids. His CXR is shown (Fig. 61.1).
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.