Left ventricular perforation by a chest tube: Case report and review of complications

Abstract

Objective: The placement of a chest tube to resolve pleural effusion, pneumothorax or as a diagnostic method is a relatively common invasive procedure in the emergency room and hospitalization area, which is not inherent to presenting complications. We present the case of a patient with perforation of the left ventricle secondary to the placement of a chest tube Case presentation: A 76-year-old male who was admitted to the emergency department with pneumonia and left pleural effusion. A chest tube was placed in pleural space, however, after procedure hemodynamic deterioration occurred and computed tomography (CT) revealed left ventricular perforation. Thoracotomy was performed to remove the catheter and repair the left ventricular puncture site. Although due to hemodynamic instability patient was admitted to intensive care unit with mechanical ventilation, subsequently developed cardiogenic shock. Vasopressor support was needed. An echocardiogram was performed on day 1 after the surgical intervention and showed no evidence of bleeding according to the report. After three days the patient dies from cardiogenic shock. Conclusion: In conclusion, whenever available, it is better to use a chest CT prior to placement of the chest tube and during the procedure use lung ultrasound to guide the puncture. Special care must be taken when using small caliber probes. Finally, more publications of these complications are required to have more evidence in the management of these cases. Take home message: Special care must be taken when using small caliber probes. The efficacy of lung ultrasound in guiding chest tube placement, demonstrating it is utility in improving accuracy and reducing complications.

Keywords

• chest tube
• pleural effusion
• pneumothorax
• thoracotomy