Abstract
BackgroundThe need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management.MethodsPatients < 18 years old with pigtail chest tubes placed 2014–2019 at a tertiary children’s hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion.Results111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax.ConclusionsPost-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.
Highlights
Pediatric patients undergo tube thoracostomy for a variety of reasons, including traumatic or spontaneous pneumothorax, hemothorax, pleural effusion or empyema, and following thoracic surgical procedures [1]
The majority were inserted by a pediatric intensivist (n = 43, 35%), followed by pediatric surgery and trauma surgery (n = 18, 14.6% each), and pediatric cardiothoracic surgery and interventional radiology (IR) (n = 16, 13% each)
The largest study of pediatric patients undergoing pigtail chest tube placement to date to the best of our knowledge in the English literature, we found that postpull chest X-rays (CXR) are obtained in almost all children, these images very rarely change patient management, and none resulted in immediate intervention
Summary
Pediatric patients undergo tube thoracostomy for a variety of reasons, including traumatic or spontaneous pneumothorax, hemothorax, pleural effusion or empyema, and following thoracic surgical procedures [1]. There is mounting evidence that a small pneumothorax in an asymptomatic patient does not always require chest tube reinsertion [3], and that imaging findings from post-pull CXRs rarely change patient management [4, 5]. The majority of these studies have been conducted on patients who have undergone large-bore thoracostomy tube placement. Pigtail chest tubes are smaller bore (8.5–14 Fr) and are inserted via Seldinger technique, with only a small skin incision necessary They are being used increasingly in pediatric patients with pathologies including pleural effusion [6] and pneumothorax [7]. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax
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