Successful Video-Assisted Thoracoscopic Removal of a Chest Tube Protruding Deep Into the Pulmonary Hilum

Tube thoracostomy is an invasive procedure frequently used to drain pleural fluid collections or to manage pneumothorax, wherein the lungs commonly sustain trauma. In some cases, deep pulmonary hilar injuries are managed by anatomical lung resections. A deep hilar injury with the chest tube protruding into the lung parenchyma is a rare complication of tube thoracostomy. We report the case of a patient with tube thoracostomy-related deep pulmonary laceration treated using video-assisted thoracic surgery (VATS). A 74-year-old man with a left-sided pneumonia-associated empyema underwent tube thoracostomy for drainage of intrathoracic purulent collection at another hospital; however, chest radiography and computed tomography (CT) revealed intrusion of the 22 Fr chest tube into the left lower lobe parenchyma for approximately 10 cm toward the pulmonary hilum, with the chest tube tip located near the left main bronchus and pulmonary artery. Although no massive intrapulmonary hemorrhage, pneumothorax, or pneumomediastinum was observed, multiple pyothoracic cavities were present. He was transferred to our hospital the following day in a hemodynamically stable condition. The next day, he underwent both surgical chest tube removal and decortication for empyema. Owing to the worsening of his physical condition and due to prolonged severe inflammation and lack of appetite, without any sign of bleeding or chest tube air leak, a two-port VATS with sparing of the lung parenchyma was attempted. After decortication, the penetrating chest tube was slowly removed. No hemorrhage or air leaks were observed at the site of penetration, requiring no sutures or dressing. Following his uneventful postoperative course, he was discharged on day 9. In selected cases, anatomic lung resection can be avoided, even for deep hilar injuries, depending upon the degree of intrapulmonary hemorrhage and the presence of air leak from the chest tube, and the CT scan findings.