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A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury. Respir Med Case Rep 2018; 25:109-111. [PMID: 30105202 PMCID: PMC6086391 DOI: 10.1016/j.rmcr.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 11/22/2022] Open
Abstract
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.
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Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications. World J Surg 2016; 39:2691-706. [PMID: 26159120 DOI: 10.1007/s00268-015-3158-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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Kwiatt M, Tarbox A, Seamon MJ, Swaroop M, Cipolla J, Allen C, Hallenbeck S, Davido HT, Lindsey DE, Doraiswamy VA, Galwankar S, Tulman D, Latchana N, Papadimos TJ, Cook CH, Stawicki SP. Thoracostomy tubes: A comprehensive review of complications and related topics. Int J Crit Illn Inj Sci 2014; 4:143-55. [PMID: 25024942 PMCID: PMC4093965 DOI: 10.4103/2229-5151.134182] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Michael Kwiatt
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Abigail Tarbox
- Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA
| | | | - Mamta Swaroop
- Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA ; OPUS 12 Foundation Global, Inc, USA
| | - James Cipolla
- Department of Surgery, Temple St Luke's Medical School, Bethlehem, PA, USA ; OPUS 12 Foundation Global, Inc, USA
| | - Charles Allen
- Department of Surgery, Temple St Luke's Medical School, Bethlehem, PA, USA
| | | | - H Tracy Davido
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David E Lindsey
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA ; OPUS 12 Foundation Global, Inc, USA
| | - Vijay A Doraiswamy
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA ; OPUS 12 Foundation Global, Inc, USA
| | - Sagar Galwankar
- Department of Emergency Medicine, Winter Haven Hospital, University of Florida, Florida, USA ; OPUS 12 Foundation Global, Inc, USA
| | - David Tulman
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nicholas Latchana
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thomas J Papadimos
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA ; OPUS 12 Foundation Global, Inc, USA
| | - Charles H Cook
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA ; OPUS 12 Foundation Global, Inc, USA
| | - Stanislaw P Stawicki
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA ; OPUS 12 Foundation Global, Inc, USA
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Chen YF, Chen CY, Hsu CL, Yu CJ. Malpositioning of the chest tube across the anterior mediastinum is risky in chronic obstructive pulmonary disease patients with pneumothorax. Interact Cardiovasc Thorac Surg 2011; 13:109-11. [PMID: 21486755 DOI: 10.1510/icvts.2010.264689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malpositioning is one of the most common complications of chest tube insertion and is associated with increased morbidity and mortality. We present two cases of patients with chronic obstructive pulmonary disorder (COPD) in whom malpositioned chest tubes penetrated through the anterior mediastinum to the contralateral pleural cavity, and were later removed without complications. Both patients had a relatively wide retrosternal airspace and received blunt dissection with a trocar for percutaneous chest tube insertion, which may have increased the risk of chest tube penetration through the anterior mediastinum during tube thoracostomy. Further, the precise location of the malpositioned chest tubes could not be confirmed by single-view anteroposterior portable chest radiography, and computed tomography (CT)-scan was more helpful in the diagnosis and management of the cases reported herein.
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Affiliation(s)
- Yen-Fu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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WRIGHTSON JM, HELM EJ, RAHMAN NM, GLEESON FV, DAVIES RJ. Pleural procedures and pleuroscopy. Respirology 2009; 14:796-807. [DOI: 10.1111/j.1440-1843.2009.01592.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Lim KE, Tai SC, Chan CY, Hsu YY, Hsu WC, Lin BC, Lee KT. Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph? Clin Imaging 2006; 29:401-5. [PMID: 16274893 DOI: 10.1016/j.clinimag.2005.06.032] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 07/26/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy between computed tomography (CT) and frontal chest radiography in the diagnosis of malpositioned chest tubes (MCT). MATERIALS AND METHODS CT scans positive for MCT between March 2000 and March 2004 were reviewed. Two radiologists assessed for intra- and extrathoracic locations of MCT in CT studies. Two physicians who were blinded to the results of CT scans assessed the frontal chest radiographs for location of chest tubes, within the pleural space or outside pleural space. The results of CT were then compared with the results of frontal chest radiographs. Medical records were also reviewed for function of the chest tubes and any complications induced by MCT. RESULTS CT revealed 28 MCT among the 76 chest tubes that were placed in 54 patients. Among the 28 MCT detected by CT, 23 tubes were in the intrathoracic location (20 intraparenchymal; 3 intrafissural) and 5 tubes were in the extrathoracic location (4 in mediastinum; 1 in chest wall). Frontal chest radiographs only revealed six MCT. Among 28 MCT, 16 sufficient, 8 insufficient, and 4 indeterminate functions of the chest tubes were noted from medical charts. One patient complicated with lung abscess, four patients had suffered pleural empyema, and one patient suffered active lung parenchymal bleeding, resulting from MCT. CONCLUSIONS CT is more accurate than chest radiograph for the diagnosis of MCT. For selected patients with inadequacy drainage of the tubes and when chest radiograph is noncontributory, CT scan is recommended to clarify the exact location of chest tubes.
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Affiliation(s)
- Kun-Eng Lim
- Department of Radiology, Buddist Tzu Chi Xindian General Hospital, Xiandian, Taipei County, Taiwan, ROC.
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Abstract
BACKGROUND The safe insertion of a chest drain is a skill doctors across specialties require. Incorrect placement can lead to significant morbidity and even mortality. METHODS This audit surveyed junior doctors working in a teaching hospital about their specialty and level of experience with intercostal drains. They were then asked to mark on a photograph where they would insert a chest drain for a pneumothorax in a non-emergency situation. RESULTS Of the 55 junior doctors surveyed, 45% were outside the safe area of chest drain insertion as defined by the British Thoracic Society. The most common error was a choice of insertion site too low (24%). CONCLUSIONS In this audit 45% of juniors surveyed would have placed a chest drain outside the safe triangle recommended by the British Thoracic Society. The common mistake of a choice of insertion site too low should be discussed in postgraduate teaching programmes.
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Affiliation(s)
- J R Griffiths
- Department of Cardiothoracic Surgery, Northern General Hospital, University Hospitals Sheffield, Sheffield, UK.
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Abstract
The diagnosis of pneumothorax is established from the patients' history, physical examination and, where possible, by radiological investigations. Adult respiratory distress syndrome, pneumonia, and trauma are important predictors of pneumothorax, as are various practical procedures including mechanical ventilation, central line insertion, and surgical procedures in the thorax, head, and neck and abdomen. Examination should include an inspection of the ventilator observations and chest drainage systems as well as the patient's cardiovascular and respiratory systems.Radiological diagnosis is normally confined to plain frontal radiographs in the critically ill patient, although lateral images and computed tomography are also important. Situations are described where an abnormal lucency or an apparent lung edge may be confused with a pneumothorax. These may arise from outside the thoracic cavity or from lung abnormalities or abdominal viscera inside the chest.
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Affiliation(s)
- J J Rankine
- Department of Radiology, Hope Hospital, Salford, UK
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Gayer G, Rozenman J, Hoffmann C, Apter S, Simansky DA, Yellin A, Itzchak Y. CT diagnosis of malpositioned chest tubes. Br J Radiol 2000; 73:786-90. [PMID: 11089474 DOI: 10.1259/bjr.73.871.11089474] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Insertion of a chest tube into the pleural space is standard management for various pleural disorders. Malpositioning of chest tubes in extrathoracic, intraparenchymal and mediastinal locations and in the fissures is common. Malpositioning results not only in inadequate drainage of air and fluid but may also result in increased morbidity and mortality. Diagnosis of a malpositioned tube is sometimes difficult to establish on a chest radiograph. CT, however, has proven to be extremely accurate in evaluating the position of a chest tube and has often provided additional valuable information with significant therapeutic impact.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Jantz MA, Sahn SA. Pleural Disease in the Intensive Care Unit. J Intensive Care Med 2000. [DOI: 10.1046/j.1525-1489.2000.00063.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jantz MA, Sahn SA. Pleural Disease in the Intensive Care Unit. J Intensive Care Med 2000. [DOI: 10.1177/088506660001500201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.
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Affiliation(s)
- Michael A. Jantz
- From the Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
| | - Steven A. Sahn
- From the Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
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Aru GM, Dabbs AP, Cummins ER, Reno WL, Harrison NP, English WP, Heath BJ. Selective use of chest tubes in thoracotomies for congenital cardiovascular procedures. Ann Thorac Surg 1999; 68:1376-8; discussion 1378-9. [PMID: 10543509 DOI: 10.1016/s0003-4975(99)00917-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advantages and complications have been reported from the use of chest tubes (CT). To reduce the incidence of complications we have employed a selective use of CT in thoracotomy for congenital cardiovascular procedure; ie, in absence of air leaks and fluid to be drained, no CT was inserted. METHODS The lung was reexpanded and air evacuated during the chest closure. Early and 6 hours chest roentgenograms were performed on every patient. This study retrospectively reviews the results of this selective approach in 546 patients operated on between 1980 and 1998 mainly for patent ductus arteriosum ligation, pulmonary artery band, aortic coarctation, Blalock-Taussig shunt. Four hundred and eighteen patients did not receive a CT at the initial surgery (group I), and 128 patients received a CT either before or at surgery (group II). RESULTS 40 patients in group I developed an air or fluid collection large enough to require a CT. Only one patient had complication, from an undetected hemothorax. Nine patients in group II required another CT, and one patient developed a pneumothorax upon pulling out the CT. No death in either group was related to the use or lack of use of the CT. A total of 378 CTs and collecting chambers were saved. CONCLUSIONS A selective approach to the use of CT in thoracotomies for cardiovascular procedures can be employed with minimal complications, more comfort for the patient, and cost savings.
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Affiliation(s)
- G M Aru
- Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson 39216-4525, USA. garuteclink.net
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Collop NA, Kim S, Sahn SA. Analysis of tube thoracostomy performed by pulmonologists at a teaching hospital. Chest 1997; 112:709-13. [PMID: 9315804 DOI: 10.1378/chest.112.3.709] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVE To evaluate all tube thoracostomies (TTs) done by pulmonary/critical care fellows and attending physicians in the Medical University of South Carolina's health-care system documenting patient demographics, indication for placement, size and characteristics of the tube, and associated problems. DESIGN Prospective. SETTING University health-care system, including a university hospital, a Veterans Affairs hospital, and a county hospital. PATIENTS All adult patients requiring consultation by a member of the pulmonary/critical care staff for a tube thoracostomy. RESULTS One hundred twenty-six tube thoracostomies were performed over a 24-month period in 91 patients. The most common initial indication for a TT was pneumothorax (69/103, 67%). Overall mortality in the patient population was 35% (32/91). Early problems (< 24 hours following placement) occurred in 3% (4/126); late problems (> 24 h after placement) occurred in 8% (10/126). Problems occurred in 36% (4/11) of small-bore tube placements vs 9% (10/115) of standard TT placements (p=0.02). CONCLUSIONS Tube thoracostomy can be safely performed by pulmonologists with relatively few associated problems.
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Affiliation(s)
- N A Collop
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425, USA
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Abstract
Trauma is the leading cause of death of young adults in the United States, and chest trauma is one of the leading causes of trauma-related fatalities. This article presents an approach to the radiological evaluation and diagnosis of pneumothorax, pneumomediastinum, traumatic aortic rupture, and thoracic spine injuries. Also discussed is the radiological assessment of vascular catheters, endotracheal tubes, and thoracostomy tubes.
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Affiliation(s)
- S A Groskin
- Department of Radiology, State University of New York Health Sciences Center, Syracuse 13210, USA
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Affiliation(s)
- G J Peek
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester
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