A conservative surgical approach for management of iatrogenic pulmonary artery perforation

Abstract

Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.

Catastrophic injuries caused by tube thoracostomy with trocar: a series of nine cases

“…The patient whose pulmonary artery was injured was the most catastrophic TT procedure among our case series. The number of TT cases resulting in pulmonary artery injury is quite limited in the literature and only 11 cases were reported in the PubMed field [5][6][7][8][9][10][11][12][13][14][15].…”

Traumatic injury of the pulmonary artery: Transection, rupture, pseudoaneurysm, or dissection? Sometimes semantics do matter

“…Conservative management with close clinical and imaging surveillance is recommended for asymptomatic lesions smaller than 2 cm and for PADs. 5,12,22,23 In this issue of the Journal, Demondion and colleagues 24 describe a case of a deceleration injury of the intrapericardial right PA that was successfully managed conservatively. Because of the associated intracranial injury, anticoagulation for cardiopulmonary bypass was contraindicated.…”