Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph?
OBJECTIVE
The aim of this study was to compare the accuracy between computed tomography (CT) and frontal chest radiography in the diagnosis of malpositioned chest tubes (MCT).


METHODS
CT scans positive for MCT between March 2000 and March 2004 were reviewed. Two radiologists assessed for intra- and extrathoracic locations of MCT in CT studies. Two physicians who were blinded to the results of CT scans assessed the frontal chest radiographs for location of chest tubes, within the pleural space or outside pleural space. The results of CT were then compared with the results of frontal chest radiographs. Medical records were also reviewed for function of the chest tubes and any complications induced by MCT.


RESULTS
CT revealed 28 MCT among the 76 chest tubes that were placed in 54 patients. Among the 28 MCT detected by CT, 23 tubes were in the intrathoracic location (20 intraparenchymal; 3 intrafissural) and 5 tubes were in the extrathoracic location (4 in mediastinum; 1 in chest wall). Frontal chest radiographs only revealed six MCT. Among 28 MCT, 16 sufficient, 8 insufficient, and 4 indeterminate functions of the chest tubes were noted from medical charts. One patient complicated with lung abscess, four patients had suffered pleural empyema, and one patient suffered active lung parenchymal bleeding, resulting from MCT.


CONCLUSIONS
CT is more accurate than chest radiograph for the diagnosis of MCT. For selected patients with inadequacy drainage of the tubes and when chest radiograph is noncontributory, CT scan is recommended to clarify the exact location of chest tubes.
Lim
Kun-Eng
KE
Department of Radiology, Buddist Tzu Chi Xindian General Hospital, Xiandian, Taipei County, Taiwan, ROC. kevinblueski@yahoo.com.tw
Tai
Shy-Chang
SC
Chan
Chang-Yi
CY
Hsu
Yuan-Yu
YY
Hsu
Wen-Chang
WC
Lin
Being-Chann
BC
Lee
Keong-Tiong
KT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes / Q000009:adverse effects*; D004322:Drainage / Q000295:instrumentation; D004630:Emergencies; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D013902:Radiography, Thoracic; D012307:Risk Factors; D013898:Thoracic Injuries / Q000628:therapy*; D013907:Thoracostomy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000628:therapy*