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A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury.

ABSTRACT: Malpositioning of a chest tube is a recognised complication of chest tube insertion. However, cases involving the mediastinum comprise only a fraction of such occurrences, while the complete translocation of the tube through the medisastinum is only noted in three published cases. This case report describes a case of complete translocation of the mediastinum during chest tube insertion to resolve a pneumothorax. It examines the possibility of an occult natural pathway in the posterior mediastinum of some patients based on the ease at which the tube crossed the mediastinum, the immediate resolution of patient symptoms and the absence of injury or complications from the event to the patient.

SUBMITTER: Almas ET

PROVIDER: S-EPMC6086391 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury.

Almas E T ET Gartman E E Casserly B B

Respiratory medicine case reports 20180729

Malpositioning of a chest tube is a recognised complication of chest tube insertion. However, cases involving the mediastinum comprise only a fraction of such occurrences, while the complete translocation of the tube through the medisastinum is only noted in three published cases. This case report describes a case of complete translocation of the mediastinum during chest tube insertion to resolve a pneumothorax. It examines the possibility of an occult natural pathway in the posterior mediastinu ...[more]

PMID: 30105202

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Project description:Background Although chest tube-omitted video-assisted thoracoscopic surgery (VATS) has been proven to be safe and efficacious, its universal application is precluded by a varying morbidity rate due to a lack of standardization. Since digital chest drainage has already shown improved accuracy and consistency in the management of postoperative air leak, we incorporated it in the strategy of intraoperative chest tube withdrawal, aiming to achieve better results. Methods We collected the clinical data of 114 consecutive patients who underwent elective uniportal VATS pulmonary wedge resection at the Shanghai Pulmonary Hospital from May 2021 to February 2022. Their chest tubes were withdrawn intraoperatively after an air-tightness test facilitated by digital drainage: the end flow rate had to be kept ≤30 mL/min for >15 s at the setting of −8 cmH2O suctioning. The recordings and patterns of the air suctioning process were documented and analyzed as potential standards of chest tube withdrawal. Results The mean age of the patients was 49.7±11.7 years. The mean size of the nodules was 1.0±0.2 cm. The location of the nodules encompassed all lobes, and 90 (78.9%) patients received preoperative localization. The postoperative morbidity and mortality rates were 7.0% and 0%, respectively. Six patients had clinically overt pneumothorax and two patients had postoperative bleeding that required intervention. All of the patients recovered on conservative treatment except for one case of pneumothorax that required additional tube thoracostomy. The median length of postoperative stay was 2 days; and the median time of suctioning, peak flow rate, and end flow rate were 126 s, 210 mL/min, and 0 mL/min, respectively. The median numeric rating scale for pain was 1 on postoperative day (POD) 1 and 0 on the day of discharge. Conclusions Chest tube-free VATS assisted by digital drainage is feasible with minimal morbidity. Its strength of quantitative air leak monitoring produces important measurements for the prediction of postoperative pneumothorax and future standardization of the procedure.

Dataset Information

A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury.

Publications

A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury.

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