Iatrogenic intracardiac chest tube: Echocardiographic diagnosis and management

Chest tube insertion is a routine procedure performed frequently in intensive care units, operating rooms, and emergency departments, and frequently by physicians in training. Serious complications from chest tube insertion are uncommon, but chest tube malposition may rarely lead to potentially life-threatening hemorrhage. We report such a case in which a chest tube was inadvertently placed through the chest wall and into the heart and across the aortic valve. Echocardiography was used to establish the diagnosis, assess for the presence of hemopericardium and cardiac tamponade, evaluate for valvular injury, and guide anesthetic management and surgical intervention. Physicians inserting and managing chest tubes should be aware of potential complications and diagnostic and management strategies should complications occur.