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case_images: Sequential chest X-ray of case 1. A. Signs of pulmonary hyperinflation with diaphragmatic flattening. Orotracheal tube in proper position, there are no consolidations and pleural angles are free. B. Severe right pneumothorax, subcutaneous emphysema, displacement of mediastinal structures to the left. Presence of a nasogastric tube. C. Mild pulmonary expansion with large subcutaneous emphysema. The chest tube is directed towards the pulmonary apex, a superior vena cava catheter is placed. D. Complete opacity of the left hemithorax with ipsilateral displacement of mediastinal structures, suggestive of atelectasis and presence of a hernia in the right lung. There is subcutaneous emphysema on both pulmonary fields. E. Severe right pneumothorax with complete collapse of the lung, right chest tube, mediastinal displacement to the left. F. Complete opacity of both pulmonary fields due to massive pleural effusion, right chest tubes and displacement of the trachea to the right. R: right side.
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case_images: A chest X-ray revealed a right pneumothorax, which was treated with thoracostomy, resulting in a secondary bronchopleural fistula of 50% (Figure 2).
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case_images: Appearance of the 27 Fr Avalon cannula located in the right internal jugular vein in the veno-venous system, under ultrasound guidance.
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case_images: ABG revealed mixed acidosis and severe hypercapnia, which proved refractory to management, with a MP of 7.2 J/ min, prompting the initiation of ECMO (Figure 3).
case_images: Sequential chest X-ray of case 2. A. thickening of the peribronchial weave, nasogastric tube, ECMO cannula in place and right subclavian catheter with its distal end in the right atrium. There are no areas of consolidation or pleural effusion. B. Veiling of the right costophrenic angle due to a small pleural effusion, with no areas of consolidation. C. Small band of right flat atelectasis, patent airway, presence of ECMO cannula and right subclavian catheter. D. Recovery chest X-ray showing a normal cardiac silhouette, normal pulmonary fields and a normal mediastinum.
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case_images: She was discharged after a total of 11 days (Table 3) (Figure 4).
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case_images: Sequential chest X-ray of case 4. A. Chest X-ray with adequate pulmonary expansion, orotracheal tube correctly positioned. B. A left basal opacity is identified, secondary to pleural effusion with increased retrocardiac density due to atelectasis/ consolidation, presence of ECMO cannula in right jugular vein. C. Tracheostomy cannula, pulmonary congestion and bilateral pleural effusion. D. Tracheostomy cannula, unremarkable pulmonary hila, subsegmentary bilateral basal atelectasis with small pleural effusion, enteral feeding tube and left subclavian catheter.
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case_images: The patient experienced no other complications and was discharged after a total of 19 days with a VFD score of 9 (Table 3) (Figure 5).
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case_images: PMC10929514_06
case_images: Sequential chest x-ray of case 6. A. Normal cardio aortic silhouette, central trachea, normal mediastinum, orotracheal tube in proper position. There are no consolidations, adequate pulmonary expansion. An image is observed that may correspond to a probe projected to the right intermediate bronchus. B. central trachea, orotracheal tube correctly positioned, right jugular cannula ending in the right atrium. Appearance of consolidation with air bronchogram in the left upper lobe. C. Opacity in the right lower lobe, ECMO cannula in position, enteral feeding tube. There is no evidence of pleural effusion. This image is posterior to the extraction of the foreign body located in the right intermediate bronchus. D. Image prior to discharge showing a normal trachea, normal cardiac silhouette, mediastinum and lung fields. There is no evidence of pneumothorax or pleural effusion.
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case_images: The patient experienced no further complications and was discharged after a total of 11 days (Table 3) (Figure 6).