A Case Report of Iatrogenic Pulmonary Artery Injury due to Chest-Tube Insertion Repaired under Cardiopulmonary Bypass

Gabriel, Ciss Amadou; Adama, Dieng Papa; Salmane, Ba Papa; Gaye, Magaye; Diatta, Souleymane; Mohamed, Leye; Fall, Lamine; Birame, Sene Etienne; Ndiaye, Ababacar; Oumar, Diarra; Kane, Oumar; Moustapha, Ndiaye

doi:10.1155/2013/590971

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Since these patients already have poor oxygen reserve, emergent tube thoracostomy may be indicated to help prevent impending tension pneumothorax or cardiovascular collapse [1]. While there are many well documented and discussed complications secondary to tube thoracostomies, cardiovascular complications are rare [2–6]. Even rarer are reported cases of arrhythmias as a complication of tube thoracostomy [2].…”

Section: Introductionmentioning

confidence: 99%

Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

Fashola

Kaul

Finefrock

2018

Case Reports in Emergency Medicine

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We present the case of an elderly patient who became bradycardic after chest tube insertion for spontaneous pneumothorax. Arrhythmia is a rare complication of tube thoracostomy. Unlike other reported cases of chest tube induced arrhythmias, the bradycardia in our patient responded to resuscitative measures without removal or repositioning of the tube. Our patient, who had COPD, presented with shortness of breath due to spontaneous pneumothorax. Moments after tube insertion, patient developed severe bradycardia that responded to Atropine. In patients requiring chest tube insertion, it is important to be prepared to provide cardiopulmonary resuscitative therapy in case the patient develops a life-threatening arrhythmia.

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Section: Introductionmentioning

confidence: 99%

Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

Fashola

Kaul

Finefrock

2018

Case Reports in Emergency Medicine

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“…In Molnar TF study, bleeding was the most common complication, and it was related to intercostal vein or artery injury (reported to be up to 75% of serious complications) [4]. However, other intrathoracic vessels can be injured as well, with a lower incidence but with significantly higher morbidity and mortality [15]. In the present study, during ICD insertion, patients experienced pain and bleeding; however, the difference between the two methods was not statistically significant.…”

Section: Resultsmentioning

confidence: 54%

Assessment of Surgical Outcome of Trocar versus Blunt Dissection Technique for Intercostal Drainage Insertion: A Prospective Interventional Study

Thomas,

Pujar,

Anilkumar

et al. 2024

IJARS

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Introduction: Chest tube insertion is a common procedure designed to alleviate the accumulation of air, fluid, pus, or blood in the pleural cavity. Despite being a bedside procedure often performed by emergency residents, Intercostal Drain (ICD) tube insertion carries associated risks, if not executed with care. Complications such as misplacement, organ injury, bleeding and pain are noteworthy concerns. Aim: To assess surgical outcome of Trocar versus Blunt dissection technique for ICD insertion. Materials and Methods: The present prospective interventional study was conducted in the Department of General Surgery, M S Ramaiah Hospitals, Bengaluru, India, from September 2018 and August 2020, with a sample size of 64 after obtaining Institutional Ethical Committee approval. Patients requiring ICD insertion were divided into two groups: Blunt (group A) and Trocar (group B) dissection, with 32 participants in each group. Demographic, clinical and diagnostic data were meticulously documented. Statistical analyses, including descriptive statistics, t-tests and Chi-square test, were employed to compare variables such as insertion time, complications and pain scores. Both groups were assessed for the time required for insertion and complications with each method during and after the procedure. Results: The mean age among subjects with the Blunt dissection method and Trocar method was 45.53±14.85 years and 45.06±10.46 years, respectively. In the Blunt dissection technique, 6 (18.8%) were females and 26 (81.3%) were males, while of those who underwent the Trocar method of insertion, 7 (21.9%) were females and 25 (78.1%) were males. The present study findings revealed that the Trocar method demonstrates comparable surgical outcomes to the Blunt dissection method. Trocar insertion proves notably quicker, especially in obese patients. The time taken for insertion was significantly longer (p-value<0.001) with the Blunt dissection method (17.53±8.835 min) compared to the Trocar method (2.31±0.998 min). Significantly more pain was experienced by patients with the Blunt dissection method compared to the Trocar method on day 1 (p-value<0.001). There was no statistically significant difference found between Visual Analog Scale (VAS) score and method of insertion postprocedure. There was a statistically significant difference found between malposition and method of insertion. With the conventional method of insertion, 43.8% of patients had malposition, whereas with the Trocar method of insertion, 18.8% had malposition. Postprocedural complications, including bleeding and infection rates, were comparable between the two methods. Conclusion: In conclusion, the Trocar method exhibits similar surgical outcomes to the Blunt dissection method, with added advantages of reduced insertion time and reduced malposition. Proper training plays a pivotal role in mitigating potential complications, making the Trocar method a clinically viable option for ICD procedures.

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“…Only in proven cases of significant major vascular injury, consider to go on CPB support and repair the vessel by trans-sternal approach, as long as there is no contraindication. [6,14,15] In our case, the patient had post-COVID bilateral lung fibrosis with severe PAH, which was a relative contraindication for CPB. CT chest was showing chest tube entering right pulmonary artery from the interfissure branch, so went ahead with thoracotomy without cardiopulmonary bypass support.…”

Section: Discussionmentioning

confidence: 70%

Iatrogenic Insertion of Chest Tube inside the Right Pulmonary Artery: Unique, Unheard Complication, and Management

Haridas¹,

Shah²,

Shah³

et al. 2021

JMSH

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A 75-year-old male patient referred from a medical college for emergency surgical removal of chest tube from the right pulmonary artery, inserted while treating a right-sided pneumothorax. The patient was a known case of COVID pneumonia treated successfully, 2 months back. The patient developed sudden breathlessness and chest pain with saturation of 70%. The patient had gone to nearest medical college for evaluation. Chest X-ray showed right-sided pneumothorax. Chest physician inserted intercostal chest tube. After insertion of chest tube, the patient drained 1500 ml of frank blood. Chest tube clamped and referred to a tertiary care center. Emergency computed tomography (CT) pulmonary angiogram is done. It showed chest tube tip in the right pulmonary artery. In view of post-COVID, severe interstitial lung disease, patient was not suitable for open heart surgery with the support of heart-lung machine. The patient was stable when we were received; saturation was 90% with 5 L oxygen. CT chest showed diffuse fibrosis and resolving pneumonia. Echo showed severe pulmonary arterial hypertension. We did high-risk off- pump right thoracotomy and removed chest tube without much loss of blood. The injured right pulmonary artery repaired. Post-operative period was free of events and discharged successfully. In complicated cases, preferably thoracic surgeon and a well-trained, experienced chest physician should insert chest tube to avoid life-threatening complications.

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A Case Report of Iatrogenic Pulmonary Artery Injury due to Chest-Tube Insertion Repaired under Cardiopulmonary Bypass

Cited by 9 publications

References 4 publications

Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

Assessment of Surgical Outcome of Trocar versus Blunt Dissection Technique for Intercostal Drainage Insertion: A Prospective Interventional Study

Iatrogenic Insertion of Chest Tube inside the Right Pulmonary Artery: Unique, Unheard Complication, and Management

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