Potential complications of thoracostomy tube placement

Potential complications of thoracostomy tube placement

Persistent pneumothorax and extensive subcutaneous emphysema may occur if side holes are located external to the rib cage and pleural space. Lung laceration with bronchopleural fistula may also occur with a persistent pneumothorax, pneumomediastinum, or extensive subcutaneous emphysema and is more commonly seen with preexisting lung disease or pleural adhesions. Laceration or injury of an intercostal artery, phrenic nerve, thoracic duct, diaphragm, liver, spleen, stomach, mediastinum, heart, breast, or pectoralis muscle may also occur. Placement within an interlobar fissure is common, which may cause poor tube function, and is best seen on CT. Soft tissue or pleural infection may occur adjacent to the tube insertion site. Unilateral reexpansion pulmonary edema may be seen with rapid pleural decompression, and rapid development of an infiltrate at the tip or side holes may be due to pulmonary infarction from suction of lung tissue. High insertion in the posterior chest wall may lead to Horner syndrome, and recurrence of a pleural collection, pleurocutaneous fistula, or retention of a tube fragment are potential complications after tube removal.