[The intrapulmonary pseudo-malposition of chest tubes in the computed tomogram (CT)]

The diagnosis of an intrapulmonary malposition of chest tubes on CT may be problematic. We report about 13 chest tubes which were suspected on CT to be in an intrapulmonary malposition. In all cases as well as clinical and radiological follow up ruled out such a malposition. The use of a stiff tube and the presence of a soft lung parenchyma obviously led to a sinking of the tube into a "channel". Whereas after removal of the tube in case of such a pseudo-malposition solely a transitory local fluid collection and later a tender scar is seen, real intrapulmonary malposition leads to parenchymal injury and concomitant complications. The diagnosis of intrapulmonary malposition should be doubted, if the drain is positioned within the pleural space after having crossed the lung parenchyma in a supposed intrapulmonary rout. The CT criteria of this pseudo-malposition are presented and discussed.