Presentation
Out-of-hospital VF arrest. Intubated.
Patient Data
ETT projects 4.5 centimeters superiorly to the carina.
Tooth (with an amalgam filling) projects over the bronchus intermedius, causing a degree of segmental collapse with increased opacity in the right lower zone.
Left lung and both pleural spaces are clear. Cardiomediastinal contour is within normal limits.
Red circle highlights position of aspirated tooth.
Case Discussion
Given the history (lack of trauma), the presumption would be that the tooth was dislodged during intubation.
Dental injuries are rare, occuring most commonly during intubation (50%) followed by extubation (23%) with the maxillary incisors being the most at risk.
Aspiration of a tooth will generally require bronchoscopy for removal.
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