CT and radiographic assessment of tube thoracostomy

Conventional chest radiography and computed tomography (CT) were used to evaluate tube thoracostomy drainage of pleural empyema in 26 selected patients. Frontal radiographs alone were inadequate in the evaluation of thoracostomy tube placement, as only one of 21 malpositioned tubes was identified; however, when lateral radiographs were also obtained, eight of nine malpositioned tubes were identified. Suboptimal drainage due to malpositioning was demonstrated best by CT in all 21 cases. Prolongation of hospitalization, serious complications, and death correlated with failure of early tube thoracostomy drainage as demonstrated by CT. Routine frontal and lateral chest radiographs are recommended for all patients after thoracostomy tube placement for empyema. For selected patients with empyema, early use of CT to guide tube repositioning or thoracotomy may reduce morbidity and mortality and decrease hospital costs.