Tube thoracostomy: a review for the interventional radiologist

Abstract

Small-caliber tube thoracostomy is a valuable treatment for various pathologic conditions of the pleural space. Smaller caliber tubes placed under image guidance are becoming increasingly useful in numerous situations, are less painful than larger surgical tubes, and provide more accurate positioning when compared with tubes placed without image guidance. Basic anatomy and physiology of the pleural space, indications, and contraindications of small caliber tube thoracostomy, techniques for image-guided placement, complications and management of tube thoracostomy, and fundamental principles of pleurodesis are discussed in this review.

Keywords: Thoracostomy; pleural drain; pleurodesis; tube thoracostomy.

Figure 1

A 19-year-old man status post left apical bullectomy with recurrent pneumothoraces. Computed tomography-guided placement of an 8F locking loop catheter within recurrent left apical pneumothorax. (A) A 25-gauge needle (arrow) is placed for administration of local anesthetic and procedure planning. (B) A 19-gauge introducer needle is placed into the apical pneumothorax through the anesthetized tract. (C) Following subsequent wire placement and soft tissue tract dilation an 8F locking loop catheter was placed into the apical air/fluid collection.

Figure 2

A 77-year-old man with recurrent large volume symptomatic left pleural effusions requiring frequent thoracentesis. (A) Preliminary ultrasound image demonstrate a moderate-sized left pleural effusion. (B) Using real-time ultrasound guidance, an 8F locking loop catheter (long arrow) was placed into the pleural fluid collection along left midchest laterally. (C,D) Pre- and postprocedure chest radiographs demonstrate interval improvement.

Figure 3

A 77-year-old woman with recurrent large volume symptomatic right pleural effusion requiring frequent thoracentesis. Computed tomography appearance of a tunneled PleurX^® catheter (CareFusion, Inc., San Diego, CA) (arrows). (A) Subcutaneous tunnel initiation is performed laterally to ensure the externalized component of the catheter lies along the lateral body wall for patient comfort when lying down. (B,C) Right posteroinferior pleural space entrance with fenestrated catheter positioning in the dominant fluid collection. (D,E) Preprocedure and one month postprocedure chest radiographs demonstrate interval improvement.