CTICasesConstrictive Pericarditis, Fibrothorax, and Iatrogenic Left Atrial Cannulation by Chest Tube
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
Chest CT reveals a densely calcified right pleural space (chronic fibrothorax), a constricted pericardium with biatrial enlargement, and a dilated inferior vena cava consistent with constrictive pericarditis. A chest tube, placed at an outside facility to drain a chronic pleural collection, is seen traversing the right lung parenchymal space, entering the right inferior pulmonary vein, and terminating directly within the left atrium.
Key takeaways
Attempting to drain a chronic, calcified fibrothorax using blind chest tube placement carries a severe risk of visceral injury and vascular misadventure. The path of least resistance through dense, consolidated, or scarred lung tissue can lead a chest tube directly into a pulmonary vein and the left atrium, presenting a life-threatening hemorrhage risk upon chest tube manipulation. Surgical correction on cardiopulmonary bypass is required to repair the venous and atrial defect, which can be performed concurrently with pericardiectomy if constrictive pericarditis is present.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Congenital Right Coronary Artery Aneurysm with Fistulization to the Coronary SinusCongenital
- Iatrogenic Superior Vena Cava RuptureIatrogenic
- Pulmonary Pneumocystis jirovecii Pneumonia and Cerebral Lymphoproliferative Disorder in HIVInfection
- Thymoma Associated with Pure Red Cell AplasiaNeoplastic
- Amiodarone-Induced Pulmonary ToxicityILD
- Chronic Pulmonary Thromboembolism with Pulmonary Infarction and CavitationVascular
- Endobronchial Metastasis from MelanomaNeoplastic
- Nodular Pulmonary EdemaVascular
See all cases from January 22, 2015 →
Related Iatrogenic cases
- Carotid-Jugular Fistula and Mediastinal Hematoma
- Iatrogenic Aortic Intramural Hematoma
- Accidental Placement of Aortic Stent Graft in False Lumen
- Intercostal Lung Herniation through Bilateral Thoracotomy Defects
- Esophagospinal-Parenchymal Fistula
- 180-Degree Flip of a Defibrillator along the Long Axis