Novel Approach to Apical Chest Tube Placement

Anterior approach to chest tube placement has been reported as a therapeutic option for successful management of apical pneumothorax. Potential complications of this approach include injury to intercostal vessels, lung parenchyma, and Internal Mammary Arteries (IMA), which could pose significant harm to cardiothoracic surgical patients post sternotomy, especially in those whom IMA was harvested as graft for CABG. We report a novel approach to apical chest tube placement by inserting a percutaneous pigtail catheter at the junction of the serratus anterior muscle, pectoralis minor muscle, and the axillary fold. This technique allows access to the apical area without the risks associated with classic anterior chest tube placement.