Extrapleural Malposition of Chest Tube in Pneumothorax Patient with Pulmonary Tuberculosis: Report of a Case

Abstract

Treatment of patients with pneumothorax and hemothorax is mainly by insertion of a chest tube. However, if the chest tube is not inserted into the proper position, not only will the treatment be unsuccessful, but adverse? consequences may occur which jeopardize the patient. We herein report a patient who had pulmonary tuberculosis treated for three months by anti-tuberculosis drugs, but subsequently developed progressive dyspnea. He was sent to the emergency department and a chest tube was inserted because of diagnosis of pneumothorax by chest radiography. The infection of pulmonary tuberculosis caused pulmonary fibrosis with thickening of the pleura which misled the physician to believe the thickened pleura to be the lung, while using his finger to dissect and enter the pleural space. This chest tube was inserted into the extrapleural space and not into the pleural space. Recognition of the mistake was delayed because of the rare incidience of extrapleural insertion and the difficulty in diagnosis by plain chest radiography. Chest computed tomography (CT) detacted the mistake and confirmed that the chest tube needed re-insertion. Therefore, in patients having pneumothorax with pulmonary tuberculosis after insertion of a chest tube, even if the chest radiograph seems to show normal position of the chest tube, early reevaluation of its position by a CT scan should be performed at once, whenever the chest tube does not function normally, especially in patients with chronic pulmonary disease.