title: Left mainstem bronchial intubation at an extremely short incisor-to-carina distance in a patient with severe ascites.
abstract: Unintentional left mainstem bronchial intubation after direct laryngoscopy is less common than unintentional right mainstem bronchial intubation, having only been referenced 3 times outside of the anesthesia literature. We report a case of unintentional left mainstem intubation at an extremely short incisor-to-carina distance. We hypothesize that the left mainstem intubation occurred because of a distortion of the anatomy of the tracheal bifurcation, caused by the patient's severe ascites, hepatomegaly, and collapsed right lower lobe, thus creating a shallower angle of the left mainstem bronchus from midline. The short incisor-to-carina distance can be explained by ascites-induced cephalad shift of the mediastinum.
authors.affiliation: Department of Anesthesiology, University of California San Diego, San Diego, California, USA.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Brzenski
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Benumof
mesh_terms: D001201:Ascites / Q000000981:diagnostic imaging / Q000473:pathology*; D001980:Bronchi / Q000473:pathology*; D001995:Bronchography; D001999:Bronchoscopy; D005260:Female; D006529:Hepatomegaly / Q000473:pathology; D006801:Humans; D007180:Incisor; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects*; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000473:pathology; D012720:Severity of Illness Index; D014132:Trachea / Q000000981:diagnostic imaging / Q000473:pathology*