Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_76
© Springer International Publishing Switzerland 2014
Chest Tube
(1)
Department of General Surgery, Geisinger Medical Center, 100 N. Academy Av. MC 21-70, Danville, PA 17822, USA
Abstract
Tube thoracostomy is indicated for drainage of air or fluid accumulated between visceral and parietal pleura.
Tube thoracostomy is indicated for drainage of air or fluid accumulated between visceral and parietal pleura.
1.
Indications:
(a)
Emergent:
(i)
Tension pneumothorax.
(b)
Urgent:
(i)
Pneumothorax in patients on mechanical ventilation.
(ii)
Tension pneumothorax after needle decompression.
(iii)
Pleural effusions affecting respiratory function.
(iv)
Traumatic hemopneumothorax.
(c)
Elective:
(i)
Empyema or complicated parapneumonic pleural effusion.
(ii)
Malignant pleural effusion.
(iii)
Transudates from cardiac, renal and hepatic diseases.
(iv)
Postoperative after cardiac and thoracic procedures.
2.
Contraindications:
(a)
Coagulopathy.
(b)
Pulmonary bullae.
(c)
Pulmonary collapse “whiteout” from mucus plug.
(d)
Dense pleural adhesions.
(e)
Drainage of a post pneumonectomy space.
3.
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Diagnosis:
(a)
Clinical exam: primary diagnosis for tension pneumothorax. Absent breath sounds, deviation of the trachea away from the side with the tension pneumothorax, hyper-expansion of the chest side with tension pneumothorax, increased venous pressure with dilated neck veins, and cardiorespiratory collapse.
(b)
Chest x-ray: initial diagnostic test, cheap, fast, and readily available. Will require lateral and/or decubitus views for small effusions. Bilateral effusions more commonly associated with transudates. Can also suggest diagnosis cause for the effusions (consolidation, tumors, and cardiomegaly).
(c)
Ultrasonography: available in most emergency departments and intensive care units. Operator dependent. Able to detect small amounts of pleural fluid. Useful tool for multiloculated pleural effusions and identifying landmarks before chest tube placement, especially in small children.
(d)
Computed tomography: more sensitive to differentiate pleural thickening and focal pleural masses. Main disadvantage is radiation exposure.
(e)
Magnetic resonance imaging: limited role on diagnosis of pleural disease.
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