CTICasesMediastinal Chest Tube Malposition
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Imaging findings
Initial radiograph showed a large pleural effusion. A subsequent radiograph after fluid removal showed air in the pleural space, but the chest tube was clearly outside the pleural space. A different tube was inserted, which appeared to traverse the pleural space at its entry point but then extended into the mediastinal fat adjacent to the heart, confined to the mediastinal fat rather than the pleural space. The tube was malpositioned.
Key takeaways
Even when a chest tube appears appropriately positioned on a radiograph, if it's not functioning as expected (e.g., not adequately draining fluid), there is a possibility of malposition. CT can definitively show the tube's location, revealing it to be in the mediastinal fat rather than the pleural space. This highlights the importance of scrutinizing tube position, especially if clinical efficacy is lacking.
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