CTICasesIntraparenchymal Chest Tube Placement with Pulmonary Hemorrhage
Imaging findings
A patient with right upper lobe adenocarcinoma developed an empyema from an infected tunneled pleural catheter, which was removed, and then had a pigtail catheter placed for drainage. CT shows the catheter looping within the posterior and lateral basal segments of the lung with adjacent central ground glass and a rind of higher attenuation resembling a pulmonary infarct; after tPA instillation, new blood appeared in the pleural space. Contrast-enhanced follow-up confirmed the catheter coursing through the parenchyma, likely having speared previously atelectatic lung when pushed through pleural adhesions.
Key takeaways
A drainage catheter can be inadvertently placed intraparenchymally, particularly when pushed through pleural adhesions, causing pulmonary hemorrhage that can appear as ground glass with an infarct-like rind. An unusual catheter course with adjacent parenchymal hemorrhage should prompt suspicion of intraparenchymal placement, confirmable on multiplanar and contrast imaging showing the catheter looping within the lung.
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