Iatrogenic haemothorax: a life-threatening complication following a 12Fg Seldinger intercostal drain insertion for pneumothorax

Abstract

A man in his 30s with no previous medical history presented to the emergency department with acute dyspnoea. His chest X-ray (CXR) showed a massive left-sided pneumothorax, and a 12Fg post-intercostal drain (ICD) was inserted. Twenty-four hours later there was evidence of blood in the drain, and he had a significant haemoglobin drop of 44 g/l in only one day. His vital signs were stable. A CXR and an urgent computed tomography (CT) scan showed a large haemothorax therefore he was transferred to the tertiary thoracic centre, where he was taken to theatre and had a thoracoscopy and evacuation of a blood clot. Follow-up two weeks later showed complete resolution of the haemopneumothorax. This case report highlights the rare complication of a massive iatrogenic haemothorax. This was despite all the safety precautions including normal coagulation and platelet count, the patient not being on any anti-coagulant drugs and an ICD approach via the triangle of safety for insertion of the small-bore tube. In the case of iatrogenic haemothorax, urgent resuscitation and surgical treatment are needed as this is a life-threatening situation.

Keywords

• intercostal chest drain
• haemothorax
• haemopneumothorax