CTICasesIatrogenic Hemothorax from Medially Placed Chest Tube Injury to Intercostal Artery
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Imaging findings
A large hemothorax developed following pigtail catheter placement. The pigtail catheter was inserted quite medially in the paraspinal area. Intraoperative findings (during drainage) confirmed active intercostal bleeding at the chest tube site. CT images showed that in the more medial/paraspinal region, intercostal vessels can dive away from the rib and run more freely within the middle portion of the interspace.
Key takeaways
When accessing the pleura, it is a standard practice to slide over the inferior aspect of the rib to avoid intercostal vessels, which typically run in the subcostal groove. However, in the paraspinal or more medial posterior interspaces, intercostal vessels can have an unpredictable course, often running more freely within the interspace. This makes them vulnerable to injury during chest tube placement, potentially leading to an iatrogenic hemothorax, emphasizing the importance of precise placement.
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