A chest tube misplaced in the heart?

Area of Science:

• Cardiology
• Thoracic Surgery
• Interventional Radiology

Background:

• Malignant pleural effusion management often requires chest tube insertion.
• The Seldinger technique is a common method for chest tube placement.
• Complications, though rare, can occur during invasive procedures.

Observation:

• A 69-year-old patient developed an inadvertent chest tube malposition.
• The 14-Fr Thal-Quick chest tube, placed via the Seldinger method, traversed the hepatic vein and entered the right ventricle.
• The patient presented with a complication of chest tube insertion for malignant pleural effusion.

Findings:

• The chest tube was confirmed to be in an unintended intra-cardiac location.
• This represents a rare but serious complication of chest tube insertion.
• Successful non-operative removal of the malpositioned chest tube was achieved.

Implications:

• Highlights the importance of meticulous technique and imaging during chest tube placement.
• Underscores the potential for rare but severe complications even with established procedures.
• Demonstrates the feasibility of non-operative management for certain chest tube malpositions.