An unusual, iatrogenic cause of massive airleak

Excerpt

A 66-year-old gentleman underwent emergency laparotomy and subsequent re-exploration for a retroperitoneal bleed. On the 10th postoperative day, he suffered a sudden deterioration with severe hypoxia and peri-arrest and was reintubated. Tension pneumothorax was suspected and he underwent needle thoracocentesis and emergent bilateral Seldinger intercostal drain insertion (ICD). He developed gross surgical emphysema (Fig. 1a) and there was a massive, continuous airleak from the left-sided ICD. CT thorax demonstrated aberrant positioning of the left ICD in the left lower bronchus and appearing to traverse the interlobar pulmonary artery (Fig. 1b). He was transferred to our hospital. At rigid bronchoscopy, the drain could be seen protruding into the left lower lobe bronchus (Fig. 1c). A bronchial blocker was placed to be deployed in the event of massive bleeding (Fig. 1d). The drain was removed under direct vision and a new chest drain was inserted. Six days later the drain was removed and the patient was transferred back to his local hospital.

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