Inadvertent chest tube insertion in congenital cystic adenomatoid malformation and congenital lobar emphysema-highlighting an important problem

Abstract

Background:Chest tube insertion in congenital cystic lung lesions is an important problem in children with acute respiratory distress having a cystic lucent lesion on chest radiograph.Objective:To evaluate the imaging findings and complications in cases of congenital cystic lung lesions with chest tube insertion and suggest the role of appropriate imaging for management of these patients.Materials and Methods:Chest radiographs and CT scans of children with congenital cystic lung lesions who had inadvertent chest tube insertion preoperatively were retrospectively reviewed for imaging appearances and complications.Results:Fifteen patients comprising 10 cases of congenital cystic adenomatoid malformation (CCAM) and 5 cases of congenital lobar emphysema (CLE) were included. Majority of the cases were infants. CCAM was misdiagnosed as complicated pneumatocele (n = 5) and pneumothorax (n = 5), while CLE was misdiagnosed as tension pneumothorax (n = 5) on the chest radiograph findings. Final diagnosis was made on CT and operative findings with histopathology. Complications noted were pneumothorax, hydropneumothorax, and infection in cases of CCAM, and change in imaging appearance and pneumothorax in cases of CLE.Conclusion:Chest tube insertion in congenital cystic lesions increases the rate of associated complications. Chest CT has a definite role in early diagnosis and deciding appropriate management in these cases.

A Four-Week-Old Infant With Respiratory Distress: An Emergency Department Case Presentation of Congenital Lobar Emphysema

“…A properly performed thoracostomy that drains the pleural space does not relieve the underlying problem, since with CLE the problem lies within the lung parenchyma. Since no extra air exists within the pleural cavity, the thoracostomy is likely to result in inadvertent puncture of the lung, and the ensuing iatrogenic pneumothorax may worsen the hemodynamic state of an already vulnerable system, potentially to the point of cardiac arrest [ 1 , 4 , 6 , 11 , 16 ].…”

Congenital Morgagni hernia presenting as complete small bowel obstruction in the adult - A case report

“…If hernia content includes the stomach, inserting a radio-opaque nasogastric tube will delineate the presence of the stomach in the chest and confirm the diagnosis. The position of herniation and contents is best delineated by the computerized tomographic scan which can also help to rule out differential diagnoses such as a mass in the thoracic cavity, congenital cystic adenomatoid malformation, and the other congenital malformations of lung parenchyma like congenital lobar emphysema [ 10 ].…”

Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management

“…It is very common to see these patients presenting to us having mistaken chest intubation. [8][9][10] We will present here our institutional experience in managing these cases.…”