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The patient, a 30-year-old obese white woman, was hospitalized for elective cholecystectomy. Except for excessive weight (222 lb [100.7 kg]) and symptoms related to gallbladder disease, history and results of physical examination were not remarkable. Preoperative chest x-ray films in both posteroanterior and lateral projections demonstrated no abnormalities.
Cholecystectomy was performed. A combined inhalational-intravenous anesthetic technique with a combination of nitrous oxide, oxygen, and curare was used. Oral-endotracheal intubation was accomplished with ease with the use of a No. 8 cuffed tube. The tube was believed to be properly placed. The anesthetic course proceeded uneventfully with respect to patient's appearance, arterialblood pressure, pulse rate, and operative conditions. Routine intraoperative cholangiograms, however, demonstrated opacification of the visible portion of the left hemithorax, suggesting atelectasis (Figure, left). Auscultation of the chest at this time did, indeed, suggest poor aeration of the left lung. The endotracheal tube was withdrawn a distance sufficient to
Hamilton WK, Stevens WC. Malpositioning of Endotracheal Catheters. JAMA. 1966;198(10):1113. doi:10.1001/jama.1966.03110230129030