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Page3/Case 03/01


The patient was intubated with a 3.5# endotracheal tube.

WHAT INVESTIGATION WOULD YOU LIKE AT THIS POINT?



An Xray was done.


ENLARGE this Xray

The endotracheal tube is10 mm below the thoracic inlet.
– There are radiolucent images of loops of bowel in the left hemithorax suggestive of a diaphragmatic hernia.
– There is a mediastinal shift to the right.

The next capillary blood gas was: pO2 30 mmHg PCO2 44 mmHg pH 7.32
– You have a triad of dyspnea, cyanosis and apparent dextrocardia

WHAT IS YOUR DIFFERENTIAL DIAGNOSIS?



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