Document Detail

Perforation of the left atrium by a chest tube in a patient with cardiomegaly: management of a rare, but life-threatening complication.
MedLine Citation:
PMID:  17303305     Owner:  NLM     Status:  MEDLINE    
Perforation of the heart is a rare, but life-threatening complication of chest tube thoracostomy. We report the very unusual case where right-sided insertion of a Matthys catheter (6 F) due to pleural effusion resulted in a left atrium perforation. Heart injury was immediately considered as a continuous flow of bright red blood emerging through the chest drain. Diagnosis was confirmed by computertomography also revealing a massive cardiomegaly due to pre-existing mitral valve regurgitation. In two consecutive thoracotomies, first the Mathys drain was removed and the heart defect closed and then the mitral valve was replaced by a bio prosthesis. The extent of the cardiomegaly and the position of the left atrium were not detected pre-operatively by chest X-ray or ultrasonic device. Despite a nosocomial pneumonia, the patient fully recovered. This case shows that extreme caution is necessary when inserting chest tubes in patients where thorax imaging by X-ray or ultrasonic device does not provide a clear anatomical site. In order to minimise complications, a blunt puncturing procedure or Seldinger technique should be used and assisted by a Doppler ultrasonic device. Also early imaging by CT and Doppler ultrasonic technique should be attempted. This may reduce incidence of severe complications as in this case.
H Kerger; T Blaettner; C Froehlich; J Ernst; T Frietsch; C Isselhorst; A K Nguyen; A Volz; F Fiedler; H V Genzwuerker
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-02-14
Journal Detail:
Title:  Resuscitation     Volume:  74     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-18     Completed Date:  2007-09-13     Revised Date:  2009-08-25    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  178-82     Citation Subset:  IM    
Department of Anesthesiology and Critical Care Medicine, Evangelian Deaconry Hospital, Wirthstr. 11, D-79110 Freiburg, Germany.
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MeSH Terms
Cardiomegaly / radiography*
Chest Tubes / adverse effects*
Heart Atria / injuries*,  radiography
Heart Injuries / etiology*,  radiography,  surgery
Tomography, X-Ray Computed

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