Perforation of the left atrium by a chest tube in a patient with cardiomegaly: Management of a rare, but life-threatening complication

Kerger, Heinz; Blaettner, T.; Froehlich, Curt D.; Ernst, J. M. P. G.; Frietsch, Thomas; Isselhorst, C.; Nguyen, Annabelle; Volz, Alexander; Fiedler, Fritz; Genzwuerker, H. V.

doi:10.1016/j.resuscitation.2006.11.008

Cited by 29 publications

(15 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, there have been a number of more serious misplacements—for example, perforation of the left atrium with a Mattheys 6F catheter and perforation of the liver with a large bore chest tube 7 8. It is not known how the risks of Seldinger drains compare with the risks of Argyle drains.…”

Section: Introductionmentioning

confidence: 99%

Survey of major complications of intercostal chest drain insertion in the UK

Harris

O’Driscoll²,

Turkington³

2010

Postgraduate Medical Journal

105

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Survey of major complications of intercostal chest drain insertion in the UK

Harris

O’Driscoll²,

Turkington³

2010

Postgraduate Medical Journal

105

View full text Add to dashboard Cite

show abstract

“…It may be associated with certain complications such as infection, bleeding, and injury to the adjacent organs [2]. Major complications to the lung, heart, great vessels or other vital organs caused by a chest tube insertion may reach 30% but are rare in the hands of experienced physicians [3]. A heart perforation during chest drain placement is a very rare complication that, to our knowledge, has been described in only ten publications to date [4].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Perforation of the Left Ventricle Following Chest Drain Insertion

Alsaiedi¹,

Fern²,

ez³

et al. 2017

JCCR

View full text Add to dashboard Cite

“…The overall complication rate of chest drain placement is reported to be as high as 30%, although the major complication rate is low if the procedure is carried out properly. Major complications include laceration of the lung, liver, diaphragm, stomach, spleen, smaller blood vessels and nerves (2). One publication reported the laceration of the left subclavian vein after chest drain placement (1).…”

Section: Discussionmentioning

confidence: 99%

“…When placing smaller chest drains (<14F) some authors recommend Seldingers' technique or image guidance to minimize the risk of fatal complications whenever possible (1). For medium (16-24F) or large (>24F) chest drains, blunt preparation and digital palpation of the pleural space with a finger is mandatory (2). If unusual resistance is discovered during drain insertion no substantial force should be applied.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic perforation of the left heart during placement of a chest drain

Goltz

Gorski²,

Bohler³

et al. 2010

Diagn Interv Radiol

View full text Add to dashboard Cite

Chest drain insertion is a widely used invasive therapy for treating pneumothorax and pleural effusions. The complication rate is low, especially if image guidance is used. Reported complications include infection, vascular lesion with bleeding, and injury to the lung, liver, diaphragm, stomach and spleen. We report on the very rare complication of left heart perforation after chest drain placement. Case reportAn 88-year-old male patient suffering from chronic heart failure was admitted to another hospital following acute cardiac decompensation. Because of dyspnea with voluminous bilateral effusions (left more than right), the patient was treated in the intensive care unit. The patient's medical history revealed chronic ischemic heart disease, peripheral artery disease (Fontaine IIb), hypertension and diabetes. Laboratory results were abnormal for hemoglobin (11 g/dL; normal, 14-18 g/dL) and creatinine (1.5 mg/dL; normal, <1.17 mg/dL). The other standard laboratory results were normal. Because of the patient's respiratory symptoms, including shortness of breath and an arterial oxygen saturation of 87%, in addition to a pharmacologic treatment an attempt was made to drain the left pleural cavity. No image guidance was used and the patient was half sitting up with his arm behind his head. After local anesthesia and under sterile conditions, an incision was made and an 8F-pleural catheter (Braun Pleuracan ® , Melsungen, Germany) was introduced into the 5 th left intercostal space in the anterior axillary line. During insertion of the drain, slight resistance was noticed at a depth of 2-3 cm. This was interpreted as adhesions and the catheter was advanced further. Immediately after insertion, blood was draining in a non-pulsatile way from the catheter so the catheter was clamped. Transthoracic ultrasound and echocardiography were performed. The imaging showed a misplaced catheter that was located within the heart.Because of these findings, and because the patient remained hemodynamically stable, he was referred to the emergency department of our university hospital where he arrived two hours after the procedure for further evaluation. During an initial clinical evaluation the patient was found to be responsive and hemodynamically stable with a blood pressure of 145/90 mmHg and a heart rate of 89/s. After this quick clinical evaluation, contrast-enhanced computed tomography (CT) of the chest was performed (Fig. 1) with the following findings: the intercostal drain had been inserted anterolaterally into the fifth intercostal space on the left; after an intrapulmonal distance of 10 mm, the drain perforated the anterolateral wall of the hypertrophic left ventricle, leaving the ventricle through the mitral valve; from here it passed through the left atrium, exiting via a pulmonary vein. The tip of the drain was located in the contralateral lung (segment 4, middle lobe). CHEST IMAGING CASE REPORT Iatrogenic perforation of the left heart during placement of a chest drainJan Peter Goltz, Armin Gorski, Jürgen Böhler, Ralph K...

show abstract

Perforation of the left atrium by a chest tube in a patient with cardiomegaly: Management of a rare, but life-threatening complication

Cited by 29 publications

References 16 publications

Survey of major complications of intercostal chest drain insertion in the UK

Survey of major complications of intercostal chest drain insertion in the UK

Iatrogenic Perforation of the Left Ventricle Following Chest Drain Insertion

Iatrogenic perforation of the left heart during placement of a chest drain

Contact Info

Product

Resources

About