Chest tube injury to left ventricle: complication or negligence?

Misadventures of a Pigtail: Case Report of Accidental Insertion of a Chest Tube Into the Left Atrium During Interventional Radiology-Guided Placement

Chest tube thoracostomy is a commonly performed procedure in the emergency department, operating room, and intensive care unit. We report an extremely rare case of accidental insertion of a chest tube into the left atrium via the right pulmonary vein during an interventional radiology-guided placement of the catheter. To our knowledge, such a case has not been reported to date. The anesthetic and surgical management of this injury are discussed.

Left ventricular perforation with catheter decompression

Thoracostomy tube placement is one of the more common procedures performed in the Emergency Department, most commonly for treatment of pneumothorax or hemothorax but occasionally for drainage of empyema or pleural effusion. Thoracostomy may be a life-saving procedure with a wide range of complication rates reported, ranging from 19.4-37%, most commonly extrathoracic placement. Most recent meta-analyses showed a relatively stable complication rate of 19% over the past three decades with the vast majority being benign in nature. We present a case with the rare complication of thoracostomy in which of a small-caliber thoracostomy tube was placed in the left ventricle. Although thoracotomy was performed to remove the catheter, the patient remained virtually asymptomatic and had an uneventful course.

A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury

Malpositioning of a chest tube is a recognised complication of chest tube insertion. However, cases involving the mediastinum comprise only a fraction of such occurrences, while the complete translocation of the tube through the medisastinum is only noted in three published cases. This case report describes a case of complete translocation of the mediastinum during chest tube insertion to resolve a pneumothorax. It examines the possibility of an occult natural pathway in the posterior mediastinum of some patients based on the ease at which the tube crossed the mediastinum, the immediate resolution of patient symptoms and the absence of injury or complications from the event to the patient.

Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service

OBJECTIVE

Until recently, traumatic cardiac arrest (tCA) was believed to be associated with high mortality and low survival rates. New data suggest better outcomes. The most common error in tCA management is failing to treat a tension pneumothorax (TP). In the prehospital setting, we prefer thoracostomies for decompressing a potential TP in tCA cases; however, interventions can only be recommended with adequate information on their results. Therefore, we reviewed the results of thoracostomies performed by our Helicopter Emergency Medical Service.

METHODS

Our Helicopter Emergency Medical Service database was reviewed for all patients who underwent a single or a bilateral prehospital thoracostomy in tCA. We evaluated the incidence of TP, the return of circulation in tCA, the incidence of infections, the incidence of sharps injuries and patient survival.

RESULTS

A total of 267 thoracostomies were performed in 144 tCA patients. Thoracic decompression was performed to rule out TP. TP was identified in 14 patients; the incidence of TP in tCA was 9.7%. Two of the tCA patients survived and were discharged from the hospital; neither had clinical signs of TP. No infections or sharps injuries were observed.

CONCLUSION

The outcomes of patients with tCA who underwent prehospital thoracostomy were poor in our group. The early identification of TP and strict algorithm adherence in tCA may improve outcomes. In the future, to reduce the risk of unnecessary thoracic interventions in tCA, ultrasound examination may be useful to identify TP before thoracic decompression.

Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications

INTRODUCTION

Although seemingly straightforward, tube thoracostomy (TT) has been associated with complication rates as high as 30 %. A lack of a standardized nomenclature for reporting TT complications makes comparison and evaluation of reports impossible. We aim to develop a classification method in order to standardize the reporting of complications of TT and identify all reported complications of TT and time course in which they occurred to validate the reporting method.

METHODS

A systematic search of MEDLINE, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews from each databases inception through November 5, 2013 was conducted. Original articles written in the English language reporting TT complications were searched. This review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Duplicate reviewers abstracted case reports for inclusion. Cases were then sorted into one of the five complication categories by two reviewers, and in case of disagreements, settled by a third reviewer.

RESULTS

Of 751 papers reporting TT complications, 124 case reports were included for analysis. From these reports, five main categories of TT complications were identified: insertional (n = 65); positional (n = 36); removal (n = 11); infective and immunologic (n = 7); and instructional, educational, or equipment related (n = 5). Placement of TT has occurred in nearly every soft tissue and vascular structure in the thoracic cavity and intra-abdominal organs.

CONCLUSION

Our classification method provides further clarity and systematic standardization for reporting TT complications.

Unexpected massive hemorrhage following the removal of a pleural drainage tube

We herein describe a case in which a massive hemorrhage unexpectedly occurred after the removal of a pleural drainage tube which had been in place for five days. One possible explanation for that event was the damage of the intercostal artery during tube insertion into the thoracic cavity. This is an extremely rare but severe complication. Therefore, the present report provides useful information for physicians who treat patients with respiratory diseases.

Thoracostomy tubes: A comprehensive review of complications and related topics

Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes.

[Perforation of the left ventricle after insertion of a chest drain: favorable outcome despite an initially unfavorable situation]

Intra-abdominal and intrathoracic misplacement is a possible complication after insertion of a chest drain but perforation of the left ventricle has very rarely been described. We report on a 57-year-old woman who had to be resuscitated due to circulatory insufficiency subsequent to cardiogenic and hemorrhagic shock after the insertion of a chest drain for the treatment of a postpneumonic pleural effusion. During surgery perforation of the left ventricle with hemopericardium was found. Despite an initially unfavorable situation the patient recovered well.