Thoracostomy tube in an interlobar fissure: radiologic recognition of a potential problem

Fourteen instances of intrafissural positioning of a thoracostomy tube were identified in 12 patients; a lateral chest film was usually required for recognition. The most common appearance was an oblique position of the tube in the major fissure (nine cases); the tube was in the minor fissure in four cases (two recognized in frontal projection). Eight of these 14 tubes were repositioned or replaced; in four cases the stated reason was poor drainage. Serial radiographs showed poor drainage in three and no drainage in three of the 14 cases. This high incidence of tube malfunction might be related to intrafissural location. To see whether major fissure placement could be recognized on frontal films alone, radiographs were made of a human model. Evenly spaced markers in a chest tube were projected closer together if the tube curved around the costal pleural space than if it entered straight into a fissure. Evenly spaced radiopaque markings on thoracostomy tubes would facilitate recognition of fissure placement, which can sometimes result in inadequate drainage.