Subclavian artery compression from a chest tube after thoracotomy in a premature infant

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Neonatal Care

Background:

• Esophageal atresia and tracheoesophageal fistula are congenital anomalies requiring surgical repair.
• Thoracotomy is a common surgical approach for these conditions.
• Chest tube placement is often necessary postoperatively for pleural drainage.

Observation:

• A right chest tube was inserted in a premature neonate during thoracotomy for esophageal atresia and tracheoesophageal fistula repair.
• Postoperatively, the chest tube was noted to have migrated superiorly into the right apical region.
• This malposition led to the occlusion of the right subclavian artery.

Findings:

• Chest tube migration into the thoracic apex can lead to vascular complications.
• Right subclavian artery occlusion is a potential iatrogenic complication of chest tube malposition.
• Partial withdrawal of the migrated chest tube successfully relieved the arterial occlusion.

Implications:

• Close monitoring of chest tube position is crucial in neonates, especially after thoracic surgery.
• Awareness of potential vascular complications associated with chest tube malposition is important for prompt diagnosis and management.
• This case highlights the need for vigilance in managing postoperative complications in premature infants undergoing complex surgical procedures.