Radiographic clues to chest tube perforation of neonatal lung

A premature infant with hyaline membrane disease who developed a pneumothorax and was treated by a thoracostomy tube subsequently died of intracranial hemorrhage. At autopsy the tube was unexpectedly found to have penetrated completely through the right upper lobe. Observation of the course of a thoracostomy tube on both frontal and lateral radiographs may give additional evidence for perforation of the lung if the tube is not located peripherally and if it does not lie in the expected location of an interlobar fissure. In turn, a heightened index of suspicion may lead to more timely operative intervention if complications ensue after placement or after removal of a thoracostomy tube that has lacerated the lung.