Report of Massive Bleed after Chest-drain Insertion in a Case of Job's (hyper-IgE) Syndrome

Abstract

Chest-drain insertion is considered to be a benign procedure. A 6-year-old girl who is a known case of hyper-IgE/Job's syndrome presented to us following three episodes of fresh bleed following chest-drain insertion for the left lung abscess. The site of bleed was localized to be the ruptured pseudoaneurysm of the anterior segmental branch of the left pulmonary artery. For successful management, various pitfalls and gray areas have been highlighted: (a) the procedure of chest-drain insertion has a potential for many complications some of which may be life-threatening, (b) the importance of proper history taking and a complete evaluation of all patients before surgical intervention, (c) role of ultrasound-guided chest-drain insertion, and (d) the importance of lateral and pragmatic approach with multidisciplinary involvement in such unusual and challenging cases cannot be overemphasized.

Keywords

• Angioembolization
• chest-drain insertion
• hyper-IgE syndrome
• intercostal tube-drain insertion
• Job's syndrome
• lung abscess
• pseudoaneurysm