Comparison of the amounts of air leakage into the thoracic cavity associated with four thoracostomy tube placement techniques in canine cadavers

Chest tube malpositioning is reported to be the most common complication associated with tube thoracostomy. Intraparenchymal and intrafissural malpositions are the most commonly reported tube sites. We present a case about a 21-year-old patient with cystic fibrosis who was admitted due to bronchiectasis exacerbation and developed a right-sided pneumothorax for which a chest tube was inserted. Partial initial improvement in the pneumothorax was noted on the chest radiograph, after which the chest tube stopped functioning and the pneumothorax remained for 19 days. Chest computed tomography was done and revealed a malpositioned chest tube in the right side located inside the thoracic cavity but outside the pleural cavity (intrathoracic, extrapleural). The removed chest tube was patent with no obstructing materials in its lumen. A new thoracostomy tube was inserted and complete resolution of the pneumothorax followed.

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Thoracic stomach syndrome after whole-stomach esophagectomy for esophageal cancer mimicking tension pneumothorax: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2251-0 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Daisuke Hasegawa ◽

Hidefumi Komura ◽

Ken Katsuta ◽

Takahiro Kawaji ◽

Osamu Nishida

Keyword(s):

Esophageal Cancer ◽

Intensive Care ◽

Respiratory Failure ◽

Nasogastric Tube ◽

Tension Pneumothorax ◽

Differential Diagnoses ◽

Tube Placement ◽

Asian Woman ◽

Thoracic Cavity ◽

Thoracic Stomach

Abstract Background Sudden onset of respiratory failure is one of the most fearful manifestations in intensive care units. Among the differential diagnoses of respiratory failure, tension pneumothorax is a life-threatening disease that requires immediate invasive intervention to drain the air from the thoracic cavity. However, other etiologies with manifestations similar to those of tension pneumothorax should also be considered after whole-stomach esophagectomy for esophageal cancer. We report a rare case of a patient with thoracic stomach syndrome mimicking tension pneumothorax after esophagectomy with whole-stomach reconstruction. Case presentation A 49-year-old Asian woman was admitted to our intensive care unit after esophagectomy for esophageal cancer with whole-stomach reconstruction while under sedation and intubated. Despite initial stable vital signs, the patient rapidly developed tachypnea, low blood pressure, and low oxygen saturation. Chest radiography revealed a mediastinal shift and led to a presumptive diagnosis of tension pneumothorax. Hence, an aspiration catheter was inserted into the right pleural space. However, her clinical symptoms did not improve. Chest computed tomography was performed, which revealed a significantly distended reconstructed stomach that was compressing the nearby lung parenchyma. Her respiration improved immediately after nasogastric tube placement. After the procedure, we successfully extubated the patient. Conclusions Similar to tension pneumothorax, thoracic stomach syndrome requires immediate drainage of air from the thoracic cavity. However, unlike tension pneumothorax, this condition requires nasogastric tube insertion, which is the only way to safely remove the accumulated air and avoid possible complications that could occur due to percutaneous drainage. For patient safety, it might be clinically important to place nasogastric tubes after esophagectomy with whole-stomach reconstruction, even if radiographic guidance is required. In addition, clinicians should consider thoracic stomach syndrome as one of the differential diagnoses of respiratory failure after whole-stomach esophagectomy.

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Successful Treatment of Bronchial Fistula after Pulmonary Lobectomy by Endobronchial Embolization Using an Endobronchial Watanabe Spigot

Case Reports in Pulmonology ◽

10.1155/2015/425694 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Yuichiro Machida ◽

Makoto Tanaka ◽

Nozomu Motono ◽

Sumiko Maeda ◽

Katsuo Usuda ◽

...

Keyword(s):

Pulmonary Resection ◽

Indigo Carmine ◽

Pulmonary Lobectomy ◽

Air Leakage ◽

Thoracostomy Tube ◽

Bronchial Fistula ◽

Endoscopic Observation ◽

Nodal Dissection ◽

Peripheral Site ◽

Right Lower Lobectomy

A bronchial fistula is one of the most serious complications that can occur following pulmonary lobectomy. We herein report a case of bronchial fistula that was successfully treated by endobronchial embolization using an Endobronchial Watanabe Spigot (EWS). A 72-year-old male underwent right lower lobectomy of the lung with nodal dissection for a pulmonary squamous cell carcinoma. A bronchial fistula developed 53 days after surgery. Tube drainage was performed, and air leakage was apparent. Under endoscopic observation, intrathoracic injection of indigo carmine revealed that a fistula existed at the peripheral site of the B2ai bronchus. After one EWS (small) was inserted into the B2a bronchus tightly using a bronchoscope, the air leakage was stopped. Pleurodesis was further carried out, the thoracostomy tube was subsequently removed, and the patient was discharged. Endobronchial embolization using an EWS is an option for the treatment of a bronchial fistula after pulmonary resection.

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Endovascular Thoracic Aortic Repair for Catheter Associated Aortic Injury During Thoracostomy Tube Placement

EJVES Short Reports ◽

10.1016/j.ejvssr.2019.11.002 ◽

2020 ◽

Vol 46 ◽

pp. 2-4

Author(s):

Edvard Skripochnik ◽

Ali Reza Sattari ◽

Thomas V. Bilfinger ◽

Apostolos K. Tassiopoulos ◽

Mohsen Bannazadeh

Keyword(s):

Aortic Injury ◽

Tube Placement ◽

Thoracostomy Tube ◽

Aortic Repair

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Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia

Journal of the American Veterinary Medical Association ◽

10.2460/javma.237.3.299 ◽

2010 ◽

Vol 237 (3) ◽

pp. 299-303

Author(s):

Yael Merbl ◽

Efrat Kelmer ◽

Anna Shipov ◽

Yael Golani ◽

Gilad Segev ◽

...

Keyword(s):

Diaphragmatic Hernia ◽

Autologous Blood ◽

Clinical Findings ◽

Thoracic Cavity ◽

Thoracostomy Tube ◽

Free Air ◽

Mixed Breed ◽

Continuous Drainage ◽

Difficulty Breathing ◽

History Of

Abstract Case Description—A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing. Clinical Findings—Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, γ-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity. Treatment and Outcome—Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood. Conclusions and Clinical Relevance—Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration > 5 days) pneumothorax when surgery is not an option.

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Thoracostomy Tube Placement and Drainage

Small Animal Critical Care Medicine ◽

10.1016/b978-1-4557-0306-7.00199-9 ◽

2015 ◽

pp. 1032-1036 ◽

Cited By ~ 3

Author(s):

Nadja E. Sigrist

Keyword(s):

Tube Placement ◽

Thoracostomy Tube

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Thoracostomy tube placement – (b) small-bore wire-guided

BSAVA Guide to Procedures in Small Animal Practice ◽

10.22233/9781905319831.2.72 ◽

2014 ◽

pp. 235-238

Keyword(s):

Tube Placement ◽

Thoracostomy Tube

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Thoracostomy Tubes and Mediastinal Drains

Chest Imaging ◽

10.1093/med/9780199858064.003.0010 ◽

2019 ◽

pp. 53-58

Author(s):

Tyler H. Ternes

Keyword(s):

Pleural Fluid ◽

Medical Devices ◽

Pleural Space ◽

Tube Placement ◽

Seldinger Technique ◽

Clinical Scenario ◽

Pleural Drainage ◽

Thoracostomy Tube ◽

Broad Term ◽

Fluid Collections

The Thoracostomy and Mediastinal Drains chapter addresses a group of medical devices used to drain intrathoracic collections of fluid or air. A chest (thoracostomy) tube is a broad term used for a variety of hollow catheters used for pleural drainage. Occasionally, the drain is placed in the mediastinum, and in these instances the term mediastinal drain is preferred. Thoracostomy tubes are typically placed in the pleural space for treatment of pneumothorax or pleural fluid. Tube sizes range from 6F to 40F, depending on the clinical scenario. Small catheters are often placed with Seldinger technique, whereas larger tubes are usually placed with blunt dissection. The tube is typically directed towards the apex in the setting of pneumothorax and towards the posterior base for treatment of pleural fluid collections. When interpreting radiographs following chest tube placement, the radiologist should ensure that the tube and sideport are positioned within the pleural space or the desired anatomic location. It is also imperative to exclude intraparenchymal or intrafissural tube placement and tube kinking.

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Ultrasound for confirmation of thoracostomy tube placement by emergency medicine residents

Trauma ◽

10.1177/1460408616649218 ◽

2016 ◽

Vol 19 (1) ◽

pp. 35-38 ◽

Cited By ~ 3

Author(s):

Damali Nakitende ◽

Michael Gottlieb ◽

Jennifer Ruskis ◽

Deborah Kimball ◽

Errick Christian ◽

...

Keyword(s):

Emergency Medicine ◽

Resident Training ◽

Tube Placement ◽

Thoracostomy Tube ◽

Single View ◽

Resident Physicians ◽

Blinded Study ◽

High Degree ◽

Identification Operator ◽

Cadaveric Model

Introduction Thoracostomy tubes are placed in the Emergency Department for numerous indications, including hemothoraces, pneumothoraces, and empyemas. After insertion, a portable single view chest radiograph is typically performed minutes later to confirm thoracostomy tubes position. However, up to 2.6% of thoracostomy tubes are ultimately determined to be misplaced. Failure to adequately drain the chest in a timely manner may have disastrous consequences. Ultrasonography by expert sonographers has been previously described to evaluate thoracostomy tubes position. The purpose of this study was to assess the accuracy of ultrasound for confirmation of thoracostomy tubes placement by Emergency Medicine residents. Methods We conducted a prospective, randomized, blinded study using a cadaveric model for ultrasound confirmation of thoracostomy tube placement by resident physicians. Thirty-five Emergency Medicine residents performed a total of 140 confirmations. The primary outcome of the study was the sensitivity and specificity of EM resident-performed ultrasonography to correctly confirm thoracostomy tube placement. Secondary outcomes included time to identification, operator confidence, and subgroup analysis by resident training level. Results The study demonstrated an overall sensitivity of 100% (95% CI 94–100%) and specificity of 96% (95% CI 87–99%) for intrathoracic placement. Post-graduate year (PGY) 1 EM residents demonstrated 100% (95% CI 76–100%) sensitivity and 100% (95% CI 76–100%) specificity. PGY 2 EM residents demonstrated 100% (95% CI 87–100%) sensitivity and 94% (95% CI 79–99%) specificity. PGY 4 EM residents demonstrated 100% (95% CI 80–100%) sensitivity and 95% (95% CI 75–100%) specificity. The total time to identification was 16 seconds (95% CI 13–19). Overall operator confidence was 4.0/5.0 (95% CI 3.8–4.1). Conclusion Emergency medicine residents were able to quickly identify thoracostomy tube location using ultrasound with a high degree of accuracy in a cadaveric model after a brief educational session.

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