Radiographically Occult Right Main Bronchus Intubation with a Fastrach Laryngeal Mask Airway Endotracheal Tube

Abstract

We report a case in which the distal 3 cm of an LMA-Fastrach laryngeal mask airway (LMA) endotracheal tube (ETT) was radiographically invisible. After the LMA intubation, left lung atelectasis developed. The radiopaque wire coil built into the ETT was mistakenly believed to mark the end of the ETT, so the radiograph made it appear that the end of the ETT was 2 cm above the main carina. In fact, this type of ETT extends 3 cm beyond the end of the wire coil, and the final 3 cm of the ETT can be difficult or impossible to see on a radiograph. Bronchoscopy revealed that the end of the ETT was in the bronchus intermedius. In this case, even in retrospect, the true end of the ETT could not be seen on the radiograph. Clinicians should be aware that the final 3 cm of the LMA-Fastrach ETT can be radiographically invisible. We believe the manufacturer should redesign this ETT to include better radiopaque markers all the way to the end of the ETT.