CTICasesBilateral Malpositioned Pleural Drains (Sub-Diaphragmatic and Chest Wall)
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Imaging findings
Initial chest radiograph after pleural drain placement shows a left pneumothorax and right upper lobe collapse, with neither pigtail catheter forming a characteristic loop, suggesting malposition. CT confirms that the left-sided drain is located within the chest wall, and the right-sided drain follows a sub-diaphragmatic course, clearly outside the pleural space. Aspiration pneumonitis and right lower lobe collapse are also present.
Key takeaways
This case demonstrates bilateral malposition of pleural drains following emergent placement for a presumed (likely iatrogenic) pneumothorax. The failure of pigtail catheters to loop correctly on chest radiographs is a critical sign of malposition, which in this case included a chest wall placement and a sub-diaphragmatic placement. Prompt CT evaluation is essential to identify such complications and guide correct placement.
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