Inability to detect unintentional endobronchial intubation by conventional signs and its detection by the radiologist during fluoroscopy for cerebral aneurysm coiling.

It is routine practice to auscultate the chest for equal bilateral breath sounds after tracheal intubation to verify that the tracheal tube tip is properly positioned. Signs of bronchial intubation also include desaturation, an increase or decrease in end-tidal carbon dioxide, and an increase in peak airway pressures. We report a case in which, during the course of endovascular coiling of a cerebral aneurysm during general anesthesia, desaturation occurred despite seemingly equal air entry on chest auscultation. The clinical picture was confused further by the presence of normal airway pressures and capnography. Incidental detection of bronchial intubation by the radiologist while performing fluoroscopy prevented any adverse sequelae to the patient and also presented an unusual method of diagnosis.