Chest Tube Malpositioning-related Hemothorax and Intra-abdominal Bleeding-A Case Report

Chest tube insertion is a standard procedure for pneumothorax, massive hemothorax, and hemopneumothorax in emergency departments. The 2 common techniques used for the insertion of chest tubes are the trocar method and blunt dissection. Although the trocar method is simpler, it is associated with a higher incidence of complications. In contrast, blunt dissection is safer and minimizes trauma to neurovascular bundles. The complications of chest tube insertion include infection, tube malpositioning, and injury to internal organs. Inadvertent malpositioning of chest tubes may cause unnecessary trauma to patients. We report a complication due to chest tube malpositioning. Computed tomography disclosed an intra-hepatically malpositioned chest tube in a patient who had undergone thoracostomy for right-side hemopneumothorax, with a continuous drainage of blood from the chest tube and hemodynamic instability. Tube thoracostomy-related hemothorax and intra-abdominal bleeding were suspected. Immediate removal of the chest tube and insertion of a new chest tube were performed. The hemopneumothorax condition stabilized after conservative management and the chest tube was removed 11 days later. Complications of tube thoracostomy are reviewed in this report.