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Radiographic clues to chest tube perforation of neonatal lung.

A premature infant with hyaline membrane disease who developed a pneumothorax and was treated by a thoracostomy tube subsequently died of intracranial hemorrhage. At autopsy the tube was unexpectedly found to have penetrated completely through the right upper lobe. Observation of the course of a thoracostomy tube on both frontal and lateral radiographs may give additional evidence for perforation of the lung if the tube is not located peripherally and if it does not lie in the expected location of an interlobar fissure. In turn, a heightened index of suspicion may lead to more timely operative intervention if complications ensue after placement or after removal of a thoracostomy tube that has lacerated the lung.

Female↗

Chylothorax--a complication of chest tube placement in a neonate.

A premature infant with respiratory distress syndrome developed a left chylothorax after evacuation of a left tension pneumothorax. The Argyle catheter noted in the posterosuperior mediastinum possibly traumatized the thoracic duct. Although the infant's chylothorax resolved with conservative management, he subsequently died of severe bronchopulmonary dysplasia. The potential complication of chylothorax from thoracostomy tubes can be prevented by avoiding penetration into the posterosuperior mediastinum.

Chylothorax↗