Managing iatrogenic pneumothorax and chest tubes

Abstract

Iatrogenic pneumothorax has become an increasingly recognized complication of routine outpatient procedures, such as transthoracic needle biopsies of the lung and transbronchial lung biopsies. Patients with clinically significant pneumothorax are typically managed with evacuation via a percutaneously placed catheter or chest tube. Tube thoracotomy and chest tube management have traditionally been performed by cardiothoracic surgeons; however, with the increasing number of interventional radiologists and interventional pulmonologists, more chest tubes are being placed by specialists who do not admit and manage patients in the hospital setting. The responsibility for the admission of these patients to the hospital service has fallen to the internist. Hospitalists caring for such patients are often expected to manage the chest tube. General internal medicine training and the existing medical literature provide few guidelines to assist with this issue. We present a discussion of the current published literature and our management algorithms for hospitalists caring for patients admitted with iatrogenic pneumothorax. Journal of Hospital Medicine 2013;8:402–408. © 2013 Society of Hospital Medicine

The risk of iatrogenic pneumothorax after electromyography

“…A chest X-ray should be obtained to look for pneumothorax, with appropriate consultation from a pulmonologist or a thoracic surgeon if a pneumothorax is identified. 10 In conclusion, needle EMG is a safe and important diagnostic tool, and the frequency of iatrogenic pneumothorax after the procedure is low. Nevertheless, electromyographers should be aware of the risk of pneumothorax, and should counsel patients accordingly.…”

“…Any patient who develops these symptoms after EMG should have immediate assessment of vital signs and should undergo auscultation of the chest. A chest X‐ray should be obtained to look for pneumothorax, with appropriate consultation from a pulmonologist or a thoracic surgeon if a pneumothorax is identified …”

Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors

“…In light of the frequency at which pneumothorax occurs following CPLB, optimizing its management is an important goal in quality improvement. All-cause iatrogenic pneumothorax is associated with an estimated additional $17,000 in cost of care and 4 days’ length of hospital stay [20]. The average cost of a lung biopsy with complications is approximately four times higher than a complication-free biopsy ($37,745 vs. $8,869)[21] based on a cost analysis performed in the United States, with the conclusion that complicated biopsies are more expensive likely being generalizable outside the United States as well.…”

Iatrogenic Pneumothorax During Parathyroid Gland Biopsy: A Case Report

“…Thus, symptoms and signs include decreased or absent breath sounds on the affected side, pleuritic pain and dyspnea, tachypnea, and tachycardia. If tension pneumothorax is present, hypotension, bradycardia, and cardiopulmonary arrest may occur [7] . The diagnosis of IPx is also similar to non-iatrogenic types.…”

“…The diagnosis of IPx is also similar to non-iatrogenic types. In conjunction with physical examination findings, radiological methods such as PA chest x-ray, thoracic computerized tomography, and thoracic ultrasonography may help the phy-Published online: 25 March 2020 sician in diagnosing IPx [7] . There are several methods to calculate the amount of pneumothorax using radiological findings.…”