January 3, 2025

13 year old girl with history of myotonic dystrophy

By Med-Challenger · 1 minute read

A 13 yo adolescent girl with history of myotonic dystrophy presents with a 2 day history of cough, nasal congestion, and several episodes of non-bloody nonbilious emesis presents in respiratory distress.

On examination her oxygen saturation is 80%, she is sleepy and minimally responsive to painful stimuli. She is intubated with fentanyl, midazolam, and rocuronium.

The post-intubation chest x-ray is shown below.

image (52)

Image courtesy of Ashley Keilman, MD

What is the most likely cause of the chest x-ray findings.

Pleural effusion
Aspiration pneumonia
Pneumothorax
Right mainstem intubation

The correct answer is:

Aspiration pneumonia

The chest x-ray showed complete opacification of the right lung with air bronchograms and mediastinal shift. It is not consistent with a pleural effusion, pneumothorax or right mainstem intubation. The ET tube terminates in the mid-thoracic trachea. The right lung opacificiation is consistent with a large aspiration event that caused the patients acute respiratory failure. Thorough assessment of bedside post-intubation chest x-rays is a critical step in airway management. [Agrawal UTD, Nagler UTD]

This question appears in Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME

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