What is the radiographic appearance of a thoracostomy tube, and where should its tip be located?
A thoracostomy tube usually appears as a faintly radiopaque tube with a thin, densely radiopaque line along the entire length of the tube. Similar to an NGT/OGT, the thin, densely radiopaque line is interrupted near the tip of the thoracostomy, representing the site of a side hole. Thoracostomy tubes should curve gently within the thorax ( Figure 22-6 ), because kinks may prevent appropriate drainage. For drainage of a pneumothorax, the tube should be positioned near the lung apex at the anterior axillary line and directed anterosuperiorly, whereas for drainage of a pleural effusion, the tube may be positioned at the midaxillary line and directed posteroinferiorly through the sixth through eighth intercostal spaces. In either case, the side hole should always be located medial to the ribs within the pleural space and not within the chest wall. Computed tomography (CT) is indicated when a thoracostomy tube does not drain air or fluid properly, and the chest radiograph is noncontributory.