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(AAN)
[1–1] [PREPRINTER stage]
Image Asian Cardiovascular & Thoracic Annals 0(0) 1 ß The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315579556 aan.sagepub.com
A malpositioned chest tube within the liver Luis Gorospe1, Gemma Marı´a Mun˜oz-Molina2 and Ana Paz Valdebenito-Montecino2
Figure 1. Posteroanterior chest radiograph shows an opacified right hemithorax (‘‘white lung’’) and a mediastinal shift towards the right side (arrows).
Figure 2. Anteroposterior chest radiograph after chest tube insertion, showing the tube in a low position (arrows). Note the shadow that corresponds to the hepatic inferior border (asterisk).
Figure 3. (A) Axial thoracic computed tomography confirming malposition of the tube within the posterior segments of the right lobe of the liver (arrows). (B) Another axial computed tomography image confirmed right main bronchus occlusion by a hilar mass (asterisk), subtotal right lung atelectasis (a), and a small right pleural effusion (p).
Chest radiography in a 76-year-old woman showed right ‘‘white lung’’ (Figure 1), and thoracentesis confirmed a yellowish right pleural effusion. Due to hypoxemia, insertion of a chest tube was decided by a physician in training who missed a classic sign of pulmonary atelectasis on the chest radiograph: mediastinal shift towards the right side. The chest tube was placed in the 9th intercostal space, but no yellowish fluid was obtained. Instead, a small amount of dark blood was aspirated. Another chest radiograph showed the chest tube in a low position and within the liver shadow (Figure 2). Computed tomography confirmed malposition of the tube within the right lobe of the liver (Figure 3) with no subcapsular hematoma or intraperitoneal bleeding, the right main bronchus completely occluded by a hilar mass (later confirmed to be lung cancer), and subtotal right lung atelectasis. The chest tube was successfully removed in the operating room.
Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.
Conflict of interest statement None declared.
1 Department of Radiology, Ramo´n y Cajal University Hospital, Madrid, Spain 2 Department of Thoracic Surgery, Ramo´n y Cajal University Hospital, Madrid, Spain
Corresponding author: Luis Gorospe, MD, Department of Radiology, Ramo´n y Cajal University Hospital, Ctra. de Colmenar Viejo Km 9.100, 28034 Madrid, Spain. Email: [email protected]
Downloaded from aan.sagepub.com at Kungl Tekniska Hogskolan / Royal Institute of Technology on December 11, 2015
(AAN)
[1–1] [PREPRINTER stage]
Image Asian Cardiovascular & Thoracic Annals 0(0) 1 ß The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315579556 aan.sagepub.com
A malpositioned chest tube within the liver Luis Gorospe1, Gemma Marı´a Mun˜oz-Molina2 and Ana Paz Valdebenito-Montecino2
Figure 1. Posteroanterior chest radiograph shows an opacified right hemithorax (‘‘white lung’’) and a mediastinal shift towards the right side (arrows).
Figure 2. Anteroposterior chest radiograph after chest tube insertion, showing the tube in a low position (arrows). Note the shadow that corresponds to the hepatic inferior border (asterisk).
Figure 3. (A) Axial thoracic computed tomography confirming malposition of the tube within the posterior segments of the right lobe of the liver (arrows). (B) Another axial computed tomography image confirmed right main bronchus occlusion by a hilar mass (asterisk), subtotal right lung atelectasis (a), and a small right pleural effusion (p).
Chest radiography in a 76-year-old woman showed right ‘‘white lung’’ (Figure 1), and thoracentesis confirmed a yellowish right pleural effusion. Due to hypoxemia, insertion of a chest tube was decided by a physician in training who missed a classic sign of pulmonary atelectasis on the chest radiograph: mediastinal shift towards the right side. The chest tube was placed in the 9th intercostal space, but no yellowish fluid was obtained. Instead, a small amount of dark blood was aspirated. Another chest radiograph showed the chest tube in a low position and within the liver shadow (Figure 2). Computed tomography confirmed malposition of the tube within the right lobe of the liver (Figure 3) with no subcapsular hematoma or intraperitoneal bleeding, the right main bronchus completely occluded by a hilar mass (later confirmed to be lung cancer), and subtotal right lung atelectasis. The chest tube was successfully removed in the operating room.
Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.
Conflict of interest statement None declared.
1 Department of Radiology, Ramo´n y Cajal University Hospital, Madrid, Spain 2 Department of Thoracic Surgery, Ramo´n y Cajal University Hospital, Madrid, Spain
Corresponding author: Luis Gorospe, MD, Department of Radiology, Ramo´n y Cajal University Hospital, Ctra. de Colmenar Viejo Km 9.100, 28034 Madrid, Spain. Email: [email protected]
Downloaded from aan.sagepub.com at Kungl Tekniska Hogskolan / Royal Institute of Technology on December 11, 2015
