Indian Journal of Critical Care Medicine Medknow Publications on behalf of the Indian Society of Critical Care Medicine ISSN: 0972-5229 EISSN: 1998-359x Vol. 15, Num. 2, 2011, pp. 142-142

Indian Journal of Critical Care Medicine, Vol. 15, No. 2, April-June, 2011, pp. 142

Letter to the Editor

Contralateral hyperinflation: Computed tomography demonstration of an unusual complication of unrecognized endobronchial intubation

Manoj Kumar Panigrahi

Department of Pulmonary Medicine, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India

Correspondence Address: Manoj Kumar Panigrahi Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006 India manojpinak@yahoo.co.in

Code Number: cm11037

DOI: 10.4103/0972-5229.83007

Sir,

I read the case report on contralateral hyperinflation by Debnath J ^[1] et al, with great interest. Though the mechanism proposed by the authors for the contralateral hyperinflation in this case is quite interesting and thought provoking, I would like to make an alternative explanation for the same which appears to me as more physiological. The collapse of the contralateral lung in an undiagnosed main stem endobronchial intubation is not an acute phenomenon. It takes about 4-24 hours for all the air to be absorbed and radiopacity to develop on the non-ventilated lung. ^[2] The immediate response in such scenario is a hypoventilation-mediated hypoxic vasoconstriction and oligemia induced decreased lung density, radiologically seen as increased translucency and paucity of vascular markings. ^[3] Improper patient positioning during imaging, which often can happen in a trauma patient, may shift the mediastinum. The patient was received after an hour of injury and underwent immediate CT scan, the imaging findings of the left lung can be normal physiological response as explained above.

References

1.	Debnath J, Kumar R, Krishna RB, Mathur A. Contralateral hyperinflation: Computed tomographic demonstration of an unusual complication of unrecognized endobronchial intubation. Indian J Crit Care Med 2011;15:52-4.  Back to cited text no. 1  [PUBMED]
2.	Felson B. The Lobes. In Felson Chest Roentgenology. New Millennium ed. London: W. B. Saunders Co, AITBS Publishers India; 2004. p. 71-142.  Back to cited text no. 2
3.	Fraser RS, Muller NL, Colman N, Pare PD. Radiologic signs of chest disease. In: Fraser RS, Muller NL, Colman N, Pare PD, editors. Fraser and Pare's Synopsis of Diseases of the Chest; 3 rd ed. Philadephia: W.B. Saunders Co, 2005. p. 111-60.  Back to cited text no. 3

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