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LETTER TO THE EDITOR
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 162

Intrapulmonary malposition of a chest drain


Intensive Care Unit of the Universitary Hospital Insular of Gran Canaria

Date of Web Publication29-Jun-2013

Correspondence Address:
Luciano Santana-Cabrera
Intensive Care Unit of the Universitary Hospital Insular of Gran Canaria, Maritima South Avenue, Postal Code- 35016

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.114279

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How to cite this article:
Santana-Cabrera L, Alemán-Pérez N, Galante-Miliqua M, Sánchez-Palacios M. Intrapulmonary malposition of a chest drain. Int J Crit Illn Inj Sci 2013;3:162

How to cite this URL:
Santana-Cabrera L, Alemán-Pérez N, Galante-Miliqua M, Sánchez-Palacios M. Intrapulmonary malposition of a chest drain. Int J Crit Illn Inj Sci [serial online] 2013 [cited 2019 Nov 17];3:162. Available from: http://www.ijciis.org/text.asp?2013/3/2/162/114279

Sir,

Chest drain placement is a standard procedure for treating pneumothorax and pleural effusions and has a low complication rate. It is a safe and efficient procedure, if image guidance is used. If the anatomic orientation is hampered and neither air nor fluids can be initially aspirated, a more complex imaging than chest radiograph is indicated, to avoid major complications.

In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a computed tomography (CT) scan of the thorax, in order to estimate the position of the chest tube. [1] Furthermore, the placement of the chest tube intrapulmonary or in the major fissure can sometimes be suspected on anteroposterior portable chest radiography because of the characteristics of the course΄s tube. In such cases a lateral radiograph would be obtained for confirmation of tube localization. [2]

We report the case of a 41-year-old male patient, who was admitted with thoracic trauma, with right pneumothorax, placing a chest tube that stayed intraparenchymal, unnoticed in the control chest radiography [Figure 1]a. This complication was diagnosed on a computed tomography scan, which was performed subsequently and was observed in the coronal, sagittal, and lateral views [Figure 1]b-d.
Figure 1: Image of the chest radiograph (a) and the computed tomography scan in the coronal, sagittal, and lateral views (b-d)

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Pneumothorax is present in about 20% of blunt major trauma cases, and the insertion of an intercostal tube for drainage is an effective form of treatment. [3] However, the procedure might have to be repeated due to ineffective drainage in patients with tube malposition, in whom the drain is not directed to the apex or is located intraparenchymal or in the fissure.

The placement of a chest tube in the lung parenchyma is a rare complication that occurs more frequently in the presence of pleural adhesions or previous lung disease.  [4] It may not lead to any clinical problem, but may cause a bronchopleural fistula, which can be massive and even fatal if it affects the pulmonary vessels. A chest radiograph taken after insertion of the tube does not show its exact location; computed tomography is the imaging technique that would give us the diagnosis of this complication. [5]

 
   References Top

1.Heim P, Maas R, Tesch C, Bücheler E. Pleural drainage in acute thoracic trauma. Comparison of the radiologic image and computer tomography. Aktuelle Radiol 1998;8:163-8.  Back to cited text no. 1
    
2.Webb WR, LaBerge JM. Radiographic recognition of chest tube malposition in the major fissure. Chest 1984;85:81-3.  Back to cited text no. 2
[PUBMED]    
3.Huber-Wagner S, Körner M, Ehrt A, Kay MV, Pfeifer KJ, Mutschler W, et al. Emergency chest tube placement in trauma care - which approach is preferable?. Resuscitation 2007;72:226-33.  Back to cited text no. 3
    
4.Legrand M, Lecuyer L, Van De Louw A, Thierry S. Pleural drain malposition. Intensive Care Med 2006;32:941-2.  Back to cited text no. 4
[PUBMED]    
5.Goltz JP, Gorski A, Böhler J, Kickuth R, Hahn D, Ritter CO. Iatrogenic perforation of the left heart during placement of a chest drain. Diagn Interv Radiol 2011;17:229-31.  Back to cited text no. 5
    


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