title: Perforation of the left atrium by a chest tube in a patient with cardiomegaly: management of a rare, but life-threatening complication.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Evangelian Deaconry Hospital, Wirthstr. 11, D-79110 Freiburg, Germany. kerger@diak-fr.de
authors.forename: H
authors.initials: H
authors.lastname: Kerger
authors.forename: T
authors.initials: T
authors.lastname: Blaettner
authors.forename: C
authors.initials: C
authors.lastname: Froehlich
authors.forename: J
authors.initials: J
authors.lastname: Ernst
authors.forename: T
authors.initials: T
authors.lastname: Frietsch
authors.forename: C
authors.initials: C
authors.lastname: Isselhorst
authors.forename: A K
authors.initials: AK
authors.lastname: Nguyen
authors.forename: A
authors.initials: A
authors.lastname: Volz
authors.forename: F
authors.initials: F
authors.lastname: Fiedler
authors.forename: H V
authors.initials: HV
authors.lastname: Genzwuerker
mesh_terms: D000368:Aged; D006332:Cardiomegaly / Q000000981:diagnostic imaging*; D015505:Chest Tubes / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000293:injuries*; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D014057:Tomography, X-Ray Computed