Use of point-of-care ultrasound and serial FAST as a monitoring tool for the removal of an ectopic chest tube in liver

Abstract

Common complications of chest tube insertion are lung laceration, chest wall bleeding, improper tube positioning, and subcutaneous emphysema. However, a penetrating injury of the upper abdominal organs due to chest tube malposition is rare. A 33-year-old suffered multiple injuries in a road traffic accident. Due to the respiratory distress caused by right-sided hemothorax, an intercostal chest drain (ICD) was inserted, which drained 500 ml of venous blood, followed by hemodynamic instability. The post-procedural chest radiograph revealed a lower chest tube position within the liver shadow. As the patient was hemodynamically stable, it was decided to delay the removal of the ectopic ICD, and the patient was kept under close monitoring. After 7 days, ICD removal was done under ultrasound guidance, and a post-procedural serial-focused assessment with sonography for trauma (FAST) was done. Hepatic injury secondary to chest tube insertion is rare, and its management is not standardised. Point-of-care ultrasound has not been used before for the removal of an ectopic ICD. We managed the case conservatively because of the stable hemodynamic situation of the patient and to avoid invasive surgery as possible. Point-of-care ultrasound can be a valuable tool in these conditions where other imaging modalities such as CT are not available and help avoid surgery.