CTICasesMalpositioned Pleural Drain (Extrapleural due to Rib Fracture)
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Imaging findings
Chest radiograph showed a pleural drain with its side port clearly outside the chest wall, despite no significant pneumothorax. Follow-up trauma CT demonstrated that the drain, after entering the interspace between ribs, deflected off a rib fracture and never actually made it into the pleural space, remaining in an extramural position.
Key takeaways
Pleural drain malposition, particularly remaining in the chest wall, is a known complication. This case illustrates how severe thoracic wall trauma, specifically rib fractures, can lead to deflection of the drain, preventing it from entering the pleural space. A classic teaching point for chest wall position is the absence of an outer margin because there's no gas around it.
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