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Congress: ECR25
Poster Number: C-27613
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-27613
Authorblock: C. García, C. Serrano Cortés, A. Blanco Barrio, A. Moreno Pastor, J. Plasencia Martínez; Murcia/ES
Disclosures:
Clemente García: Nothing to disclose
Cristina Serrano Cortés: Nothing to disclose
Ana Blanco Barrio: Nothing to disclose
Ana Moreno Pastor: Nothing to disclose
Juana Plasencia Martínez: Nothing to disclose
Keywords: Emergency, Thorax, Trauma, CT, Plain radiographic studies, Ultrasound, Complications, Treatment effects, Venous access, Education and training, Embolism / Thrombosis, Trauma
Learning objectives Highlight the pivotal role of imaging in diagnosing and managing complications associated with invasive devices used in the Intensive Care Unit (ICU). Emphasize key imaging findings that distinguish normal device positioning from pathological malposition or injury, facilitating rapid intervention and reducing morbidity and mortality. Illustrate, through a series of clinically relevant cases, how chest radiography (CXR), ultrasound (US), and computed tomography (CT) can detect diverse and life-threatening conditions such as airway injuries, malpositioned tubes, vascular perforations, pneumothorax, and organ perforations.
Read more Background Critically ill patients often require multiple invasive devices for support and monitoring, including endotracheal tubes (ETT), central venous catheters (CVCs), chest drainage tubes, nasogastric tubes (NGTs), and pacemakers. Device-related complications can worsen outcomes if not recognized promptly.Mechanisms of injury include: Traumatic placement: Excessive force, improper angle, or anatomical variation can result in airway rupture, vascular perforation, or lung parenchymal laceration. Overinflation of balloons: Leading to tracheal tears, mediastinal emphysema, and subcutaneous emphysema. Malposition/migration: Devices intended for central veins can migrate into arteries or...
Read more Findings and procedure details Study Design Retrospective review of twenty-four patients (2019–2023) at a single secondary care hospital’s ICU. Inclusion criteria: clinically or radiologically confirmed device-related complications. Imaging modalities: Portable CXR, US, and CT scans. Airway Complications Tracheal Rupture / Tear Mechanism: Overinflation of the endotracheal tube balloon or traumatic intubation. Imaging Findings: Pneumomediastinum, subcutaneous emphysema, and focal discontinuity of the tracheal wall on CT. CT is the non-invasive investigation of choice for detecting tracheobronchial injuries; however, it can miss or underestimate the true extent of these ruptures in an alarming...
Read more Conclusion Imaging is pivotal for the early detection, characterization, and management of ICU device-related complications. Chest radiography remains the first-line screening tool, but ultrasound and CT are crucial for clarifying ambiguous findings and guiding definitive treatment. The presented cases underscore the wide range of injuries—from minor to life-threatening—that can occur despite careful insertion techniques.Timely identification optimizes patient outcomes by preventing further damage, allowing for immediate device repositioning or surgical intervention. A key challenge is the shortage of human capital, often limiting...
Read more References [1] Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014;9:117. https://doi.org/10.1186/1749-8090-9-117. [2] Migliore F, Curnis A, Bertaglia E. Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach? J Cardiovasc Med (Hagerstown) 2016;17:309–13. https://doi.org/10.2459/JCM.0000000000000154. [3] Hixson R, Jensen KS, Melamed KH, Qadir N. Device associated complications in the intensive care unit. BMJ 2024;386:e077318. https://doi.org/10.1136/bmj-2023-077318. [4] Aggarwal RK, Connelly DT,...
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