Pulmonary Hemorrhage Secondary to Chest Tube Placement for Pneumothorax in Neonates

Abstract

We report two neonates in whom placement of a chest tube for pneumothorax was followed by hemorrhage, shock, and subsequent death. An autopsy of one of the patients led us to the conclusion that bleeding had occurred from lung perforation. The intercostal artery had been clearly severed and may have contributed to the hemorrhage. We discuss pathogenesis, diagnosis, and offer suggestions for proper placement of the tube.

Stitch in time: Life‐saving thoracotomy for treatment of neonatal haemothorax

“…Pneumothorax is a relatively frequent complication of respiratory disease and its management in newborns 2 . It is more frequent in neonatal period than at any other time in life.…”

“…The clinical presentation of haemothorax manifests either as haemodynamic or respiratory instability. It is not unusual to have blood‐tinged fluid in the chest tube following insertion but persistence of a bloody drainage should alert the clinician to the possibility of haemothorax with potential for subsequent death 2 . Jung et al .…”

“…Pneumothorax is a relatively frequent complication of respiratory disease and its management in newborns. 2 It is more frequent in neonatal period than at any other time in life. The risk for pneumothorax is increased with RDS, MAS, pulmonary hypoplasia and need for mechanical ventilation.…”

“…It is not unusual to have blood-tinged fluid in the chest tube following insertion but persistence of a bloody drainage should alert the clinician to the possibility of haemothorax with potential for subsequent death. 2 Jung et al reported two cases where placement of a chest tube led to pulmonary haemorrhage following intercostal artery laceration. 2 The lesions were diagnosed on autopsy and the authors speculated that thoracotomy and ligation of the lacerated artery could have controlled the haemorrhage.…”

“…1 Most cases are recognised retrospectively at autopsy. [2][3][4] We report an intact survival in a patient with haemothorax as a result of laceration of the intercostal artery.…”