• Tuberculosis and Respiratory Diseases
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• v.67 no.1
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• pp.59-62
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• 2009

Reexpansion pulmonary edema is not a common phenomenon after chest tube insertion but some reports from 0% to 14%. There are various resulting complications, including acute respiratory distress syndrome. We report a case of focal reexpansion pulmonary edema after chest tube insertion. A 49-year-old male came to the hospital due to ongoing dyspnea and left chest pain for 3 days. On chest X-ray, the patient had a left pneumothrax. We planned to insert a chest tube for symptom relief. To determine whether or not the chest had expanded as a result of the chest tube insertion, the patient underwent repeated chest X-rays the following day. The patient experienced brief respiratory symptoms upon initial suction; a chest PA showed patchy consolidated infiltration at the inserted site. After 5 days of conservative management, the recovered completely.

• Journal of Chest Surgery
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• v.26 no.8
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• pp.664-666
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• 1993

A technique for insertion of a long silicone T-tube in patient with critical stenosis and high-risk resection and primary anastomosis of long segment of the distal trachea is presented. It was not easy to insert a long T-tube by existing methods because of flexibility of a T-tube and tightness of stenosis. So we used a silastic endotracheal tube and guiding wire as stylet of a T-tube. During insertion, ventilation was normally maintained through the lumen of endotracheal tube. This provided rapid relief from airway obstruction and asphyxation and is a easy, safe and effective method to restore patency of the major airways.

• Journal of Chest Surgery
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• v.53 no.2
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• pp.49-52
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• 2020

Background: Primary spontaneous pneumothorax is commonly treated with chest tube insertion, which requires hospitalization. In this study, we evaluated the efficacy, costs, and benefits of a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) compared with a conventional chest tube. Methods: We retrospectively analyzed all primary spontaneous pneumothorax patients who underwent treatment at Gangnam Severance Hospital between August 2014 and May 2018. Results: A total of 279 patients were divided into 2 groups: the conventional group (n=236) and the Thoracic Egg group (n=43). Of the 236 patients in the conventional group, 100 were excluded because they underwent surgery during the study period. The efficacy and cost were compared between the 2 groups. There was no statistically significant difference between the groups regarding recurrence (conventional group, 36 patients [26.5%]; Thoracic Egg group, 15 patients [29.4%]; p=0.287). However, the Egg group had statistically significantly lower mean medical expenses than the conventional group (433,413 Korean won and 522,146 Korean won, respectively; p<0.001). Conclusion: Although portable small-bore chest tubes may not be significantly more efficacious than conventional chest tubes, their use is significantly less expensive. We believe that the Thoracic Egg catheter could be a less costly alternative to conventional chest tube insertion.

• Journal of Chest Surgery
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• v.49 no.3
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• pp.185-189
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• 2016

Background: For treatment of pneumothorax in Korea, many institutions hospitalize the patient after chest tube insertion. In this study, a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) was used for pneumothorax management in an outpatient clinic. Methods: Between August 2014 and March 2015, 56 pneumothorax patients were treated using the Thoracic Egg. Results: After Thoracic Egg insertion, 44 patients (78.6%) were discharged from the emergency room for follow-up in the outpatient clinic, and 12 patients (21.4%) were hospitalized. The mean duration of Thoracic Egg chest tube placement was 4.8 days, and the success rate was 73%; 20% of patients showed incomplete expansion and underwent video-assisted thoracoscopic surgery. For primary spontaneous pneumothorax patients, the success rate of the Thoracic Egg was 76.6% and for iatrogenic pneumothorax, it was 100%. There were 2 complications using the Thoracic Egg. Conclusion: Outpatient treatment of pneumothorax using the Thoracic Egg could be a good treatment option for primary spontaneous and iatrogenic pneumothorax.

• Tuberculosis and Respiratory Diseases
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• v.81 no.2
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• pp.106-115
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• 2018

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (${\leq}14F$) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

• Journal of the Korean Society of Radiology
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• v.9 no.7
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• pp.467-471
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• 2015

This study's purpose is improve image quality to keep accurate tube angle in order to recognize distortion degree conditions by patient's position or tube angle and to provide exact clinical informations when taking chest AP projection for patient which have L-tube in stomach. The experimental equipment was ELMO-T6S by SHIMADZU corporation, then we put L-tube which attached 1 mm gap scales ruler on chest phantom surface. The experiment set by 90 kVp, 4 mAs, 120 cm distance. Each phantom position which changed supine, 30degree, 45degree, 60degree on the table exposured direct, ${\pm}5degree$, ${\pm}10degree$, ${\pm}15degree$ to head and feet directions. As a result, L-tube tip's position was changed by patient's position and tube angle. When patient's position is supine, tip's position change was lower than 30degree, 45degree, 60degree. We have to adjust patient's position or tube angle in order to occur image distortion by fault tube angle when confirming correct position L-tube tip through chest x-ray. Also, Radiological technologist try to make accurate evaluation index for satisfied L-tube insertion.

• Tuberculosis and Respiratory Diseases
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• v.43 no.3
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• pp.403-409
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• 1996

Background : Pleural fluid collections may pose a difficult therapeutic problem. Complete drainage of complicated effusions or empyemas and reexpansion of atelectatic lung are important in obtaining a satisfactory clinical outcome. The usual approach to the diagnosis and treatment of patients with pleural effusion and empyema has been with needle thoracentesis and chest tube drainage. With chest tube drainage, technical difficulties and failures may occur as a result of improper tube drainage, particularly when there is a loculation or multiple and inaccesible collections. Fluoroscopic or sonographic guidance facilitates the proper tube insertion and drainage. Method : Twenty eight patients were required for tube drainage due to pleural fluid collections between January 1994 to February 1996. The author compared the results of drainage under applying each different method between blind chest tube insertion and image guided catheter insertion. Results : The conventional blind chest tube group comprised 14 patients; 6 empyema, 6 tuberculous effusion, and 2 parapneumonic effusion. The image guided catheter group of smaller french were composed of 14 patients; 2 empyema, 6 tuberculous effusion, 5 parapneumonic effusion, and 1 effusion of undetermined origin. Radiologic improvement with successful drainage was noticed in 79% with the blind chest tube group, whereas in 93% with the image guided catheter group. The complication with the latter method was unremarkable. Conclusion : Image guided catheter drainage was safe and highly successful in treating patients, not only with complicated effusion also with loculated empyema. Image guided catheter drainage offers an alternative in patients in whom closed drainage is required as the initial treatment.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.627-629
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• 2003

The pneumopericardium following blunt chest trauma is exceedingly unusual. A patient was admitted to the emergency room after a motorcycle accident. Pneumopericardium and left pneumothorax were not detected on initial chest AP, but they were detected on chest computed tomograpy and resolved completely after chest tube insertion into the left pleural space.

• Tuberculosis and Respiratory Diseases
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• v.40 no.4
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• pp.449-453
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• 1993

A 64-year-old male was admitted due to abruptly developed, severe dyspnea via local clinic. He had been a heavy smoker and alcoholic for a long time. Chest PA showed huge haziness in right upper lung field. Sputum culture for bacteriology was positive for Klebsiella pneumoniae. Immediately, appropriate antibiotics were administered and artificial ventilation was started. On 40th hospital day, simple chest roentgenogram taken due to sudden aggravated dyspnea showed marked hyperlucency in right upper lung field, suggestive of rupture of abscess cavity and resultant pneumothorax. At that time, chest tube was inserted but air leakage from the chest tube persisted. Chest CT scan taken after chest tube insertion showed the tube inserted into a thin-walled cavity in the above lesion. on 84th hospital day, right upper lobectomy with decortication was performed. Pathologically, cavittary lung abscess was diagnosed on the findings of partial re-epithelialization of ciliated columnar epithelium with severe pulmonary vascular occlusion and extensive fibrous pleural adhesions.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.1101-1105
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• 1989

Fifty one patients with empyema thoracic were managed at the Kyung Hee University Medical Center during 5 years between December, 1982, and December, 1987. The patients were classified into two groups; group A [early minithoracotomy-9 patients] and group B[conventional chest tube insertion-42 patients]. Each group was retrospectively analyzed to compare the results in terms of leukocyte count change, body temperature change, duration of hospitalization, elapsed time to chest tube removal and the need for subsequent decortication and tube change. There was no statistical difference between two groups in terms of etiology, age and sex. l. In the group A, mean preoperative leukocyte count [19,300/mme] decreased to 8,688/mme postoperatively. In the group B, leukocyte count changed from 16,985/mme to 14,433/mme. Their differences were significant [P< 0.05]. 2. In the group A, mean preoperative body temperature [38.5] decreased to 36.7. In the group B, body temperature changed from 38.1oC to 37.5 oC. Their differences were significant [P < 0.05]. 3. Mean duration of Hospitalization; 18.2 days [group A], 30.2 days [group B]. Their differences were significant [P < 0.01]. 4. Mean elapsing time for chest tube removal; 15.2 days [group A], 28.5 days [group B]. Their differences were significant [P < 0.01]. 5. There was no need for subsequent decortication and chest tube change in the group A. There were 22 cases [52.3 %] for subsequent decortication and 12 cases [28.6 %] for chest tube change in the group B. Early minithoracotomy in treating empyema thoracis resulted in a shorter hospital stay and a shorter period of tube drainage than conventional method.