Landay Michael, Oliver Qian, Estrera Aaron, Friese Randall, Boonswang Narongsak, DiMaio John Michael
Departments of Radiology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA.
J Thorac Imaging. 2006 Aug;21(3):197-204. doi: 10.1097/01.rti.0000213644.57288.2f.
We have analyzed the radiographic and computed tomographic (CT) appearance of thoracostomy (chest) tubes inadvertently placed into the lungs. We have studied the clinical sequela of such malpositioning and discussed treatment options. Cases were collected from chest CT log book reports between January 1998 and January 31, 2005 which indicated or suggested intrapulmonary thoracostomy tube placement. CT scans were reviewed by the authors. The chest radiographs and medical records--including thoracic surgical reports--of those patients whose scans demonstrated intrapulmonary tube placement or indeterminate tube location were reviewed. Fifty patients, in whom 51 thoracostomy tubes were placed into the lungs, are included in this series. None of these tubes were described as intrapulmonary on reports of chest radiographs done before CT scanning. In 13 patients (26%), thoracostomy tube placements produced immediate improvement in pleural abnormalities. Dramatic increase or development of chest wall emphysema or pneumothorax was noted in 4 (8%) patients after tube placement. Twenty-five patients (50%) demonstrated either abrupt or gradual increase in pulmonary or pleural opacity on postplacement chest radiographs. Twenty-one (42%) had no apparent clinical complications. Thirteen (26%) had either prolonged air leaks or recurrent pneumothorax. Ten (20%) developed pneumonia. Retained hemothorax or empyema occurred in 8 (16%). Twelve patients (24%) required subsequent thoracic surgery. Intrapulmonary placement of thoracostomy tubes is probably more common than previously reported. This possibility should be considered when radiographs and CT scans are evaluated.
我们分析了意外置入肺内的胸腔引流（胸）管的X线和计算机断层扫描（CT）表现。我们研究了这种误置的临床后果并讨论了治疗方案。病例收集自1998年1月至2005年1月31日期间的胸部CT日志报告，这些报告显示或提示胸腔引流管置入肺内。作者对CT扫描进行了回顾。对扫描显示胸腔引流管置入肺内或位置不确定的患者的胸部X线片和病历——包括胸外科报告——进行了回顾。本系列纳入了50例患者，其中51根胸腔引流管置入了肺内。在CT扫描前的胸部X线片报告中，这些引流管均未被描述为置入肺内。13例患者（26%）胸腔引流管置入后胸膜异常立即改善。4例（8%）患者在置管后出现胸壁气肿或气胸急剧增加或出现气胸。25例患者（50%）在置管后的胸部X线片上显示肺部或胸膜混浊突然或逐渐增加。21例（42%）无明显临床并发症。13例（26%）出现持续性漏气或复发性气胸。10例（20%）发生肺炎。8例（16%）出现胸腔积血或脓胸残留。12例患者（24%）需要后续的胸外科手术。胸腔引流管置入肺内可能比之前报道的更为常见。在评估X线片和CT扫描时应考虑这种可能性。
