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How An Endotracheal Tube Cuff Leak Be Evaluated?

Posted on Sat, 27 Aug 2016

Question: Hi
How can i see a tracheal leack in the thorax CT?
two years ago, i had a abszess after thyroid surguery with a tracheal leack, which was only see the tracheal scar on the complete thyroid surguery one month later. Now i had a thorax ct by susbicion of a pulmonary embolism and i think there is a new small leack

How can I upload the DICOM folder?

Answered by Dr. Vivek Chail (2 hours later)

Brief Answer:
It is difficult to visualise tracheal leak in CT for pulmonary embolism

Detailed Answer:
Hi,
Thanks for writing in to us.

Tracheal leak is a rare complication and there is a communication between the trachea and the esophagus.

This can be visualised in in CT scan if an oral contrast is given and the same is found in the trachea and lungs.

Without oral contrast it is extremely difficult to visualise small leaks.

In a CT scan for pulmonary embolism evaluation oral contrast is not given and therefore it will be difficult to visualise a small tracheal leak in this study.

You can upload DICOM folder to dropbox or google drive and share the download link.

You might discuss oral gastrografin xray procedure with your doctor if you feel that a tracheal leak needs to be ruled out without doing another CT scan.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (15 hours later)

Thanks for the answer. It was not a leak, it was a hole and it was on the front of the trachea. The air was visible in the ct scan. During the abscess- surgery (big abscess, which were in all layers) they searched the hole with bronchoscopy but they didn’t find it, and therefore they said, there is no hole. But one month later at the completing surgery the surgeon saw a big scar on the trachea. So there was a hole.
And now since a few weeks I have the feeling there is something again in front of the trachea. I have the feeling I see something in the CT, however I am not an expert. The position ….. The current CT was made, because there was the suspicion of a pulmonary embolism, and therefore they checked only for that.
Whenever I breathe in, then over the breastbone is a kind of suction, which is visible from outside: The skin moves more inwards, as it is normal

You find enclosed two CT’s:
1. New CT (July 2016): www.amdaconsulting.ch/xfer/New.zip
2. Old CT (Spring 2015): www.amdaconsulting.ch/xfer/Old.zip (Please ignore the MRI, which is also part of this download)

Another question; at the position axial se7 / 51760 is there a swirl fissure?

Thanks al lot

Dates:
4/2014 hemithyreoidectomy
four days later abscess surgery
5/2014 completing surgery
5/2015 minimal invasive Thymectomie (seronegative Myasthenia gravis)

Sorry the position for the possible fistula is:
SE 9 axial 11/60 - 12/60 and SE7 sagital around 56/107

the swirl position ist naturally at SE7 51/60

Thanks for your help
best regards XXXXXXX

Answered by Dr. Vivek Chail (22 hours later)

Brief Answer:
There is no fistula in the images uploaded

Detailed Answer:
Hi,
Thanks for writing back.

Sorry for the delay as it took a while to download your images.

In the thinnest possible (1.0 mm) sections I did not find any fistulous communication between the trachea and esophagus.

The suspicious area in Se 9 axial 11/60 and 12/60 is a partial volume and not a fistula.

The swirl position is normal.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Vivek Chail (3 hours later)

Thanks for the answer. But I did`t mean between the trachea and esophagus, rather between the trachea and the region in front of the trachea, there would be a tracheotomy .

And concerning swirl; I didn`t mean the position, I thought the diagonal line into the swirl

Thanks for your answer again :-)

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer:
There is no fistula in front of the neck either

Detailed Answer:
Hi,
Thanks for writing back with an update.

I have re checked the pictures and there is no fistula between the trachea and the region in front of it either.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar