Chest Tube Malfunction

  • Etiology: placed in patients who require drainage of air or fluid in the pleural space
  • Imaging: chest tube tip should be within the pleural space
  • Complications: initial malposition of chest tube tip into subcutaneous tissues or lung, migration of chest tube tip out of pleural space, bronchopleural fistula
  • Treatment: repositioning of the chest tube tip into the pleural space or placement of a new chest tube into the pleural space
  • Clinical: presents with non-reduction in the size of a pneumothorax or pleural effusion after chest tube placement or reaccumulation of pleural air or pleural fluid after successful placement of a chest tube

Cases of Chest Tube Malfunction

CXR of chest tube malfunction with chest tube in the subcutaneous tissues of the chest wall
CXR AP shows diffuse ground glass opacity throughout the lungs and a large amount of air in the right pleural space causing mediastinal shift to the left while the right-sided chest tube courses through the subcutaneous tissues of the right chest wall and never enters the right pleural space.
CT of chest tube malposition with chest tube in the lung parenchyma
Axial and coronal and sagittal CT with contrast of the chest shows a large amount of air in the left pleural space. The left chest tube is clearly located within the air space disease in the posterior left lung parenchyma in all three planes.
CXR of chest tube malposition with chest tube in the lung parenchyma
CXR AP (left) shows chronic interstitial fibrosis and scarring in the lungs, a left-sided chest tube, and a moderately-sized basilar left pleural air collection manifesting as a deep sulcus sign. Gross pathological specimen (right) shows the left chest tube entering the upper lobe of the left lung.
CXR of chest tube malfunction with chest tube migration out of the pleural space
CXR AP (above) shows left and right chest tubes within their respective pleural spaces. CXR AP (below) shows interval migration of the right chest tube out of the right pleural space into the subcutaneous tissues of the right chest wall.
CXR of bronchopleural fistula
CXR AP shows a large right pleural effusion with an air-fluid level within it – a hydropneumothorax – that is being drained by a chest tube.
CXR after congenital diaphragmatic hernia repair showing no need for a chest tube
CXR AP (above) taken immediately postop shows that the hypoplastic left lung cannot expand to completely fill the pleural space particularly in the basilar region and subsequently there is a moderate amount of air in the pleural space. This should not be called a pneumothorax. CXR AP taken 1 day later (below) shows the left pleural space now filling with fluid.