Pigtail catheter found in the Lingula of a pediatric patient on VV-ECMO while performing flexible bronchoscopy: a...

Thoracostomy tube placement is often a life-saving procedure for patients with pneumothoraces. It is frequently performed under emergent conditions because the faster the procedure is completed, the more likely the patient is to survive. However, because of the urgency of the procedure and the proximity to vital structures, damage to the thoracic organs is not uncommon. We present the case of a 10-year-old girl with cystic fibrosis and acute respiratory failure who required intubation and subsequently developed profound bilateral pneumothoraces and pneumomediastinum, prompting emergent bilateral chest tube insertion and cannulation onto veno-venous extracorporeal membrane oxygenation (VV-ECMO). Afterward, she was transferred to our hospital, where we unexpectedly found the left-sided pigtail chest tube catheter in the lingula while trying to obtain a bronchoalveolar lavage via flexible bronchoscopy. To the best of our knowledge, based on the available literature, this is a rare pediatric case of a malpositioned chest tube initially identified by flexible bronchoscopy. This case highlights the importance of vigilant evaluation of complex patients with lines, drains, and airways, as well as careful study of the way chest tubes such as pigtail catheters should appear on imaging. Additionally, it emphasizes the importance of a multidisciplinary team, including intensivists, pulmonologists, and surgeons, in patient care.