RESUMEN
Background The insertion and subsequent removal of chest tubes are frequently performed procedures for the management of pneumothoraces, pleural effusions, and cardio-thoracic surgical interventions. A chest radiograph is commonly obtained after the removal of a chest tube to rule out the interval development of a pneumothorax. This practice has been questioned in various retrospective and prospective studies conducted on surgical patient populations, showing little to no benefits in performing routine chest X-rays (CXRs) after chest tube removal unless clinical symptoms such as worsening respiratory status and hemodynamic compromise are present. Material and Methods A four-year retrospective study was conducted using the Cleveland Clinic Foundation database. A chart review was performed, and 1,032 patients were screened, with 200 patients meeting inclusion criteria. The inclusion criteria included patients who underwent chest tube insertion for non-surgical reasons. The primary outcome was the percentage of clinically significant pneumothoraces detected by routine CXR after chest tube removal. Results Out of the 200 patients included in the study, 53 had a CXR after chest tube removal showing a residual pneumothorax. Out of the 53 patients, 50 ended up not needing chest tube re-insertion, as the patients were asymptomatic and hemodynamically stable. Only three patients required chest tube re-insertion due to respiratory symptoms and significant hemodynamic changes after the chest tubes were removed. In all three cases, the symptoms manifested prior to the CXRs being obtained; therefore, the decision to reinsert each chest tubes was made based on clinical signs rather than imaging. As expected, the practice of repeating CXRs after removal of the chest tubes resulted in delayed discharges despite patients reporting no symptoms and being hemodynamically stable. Conclusions Our study findings correlate with prior smaller studies on surgical patients. Symptoms and hemodynamic data seem to be a better predictor of whether a patient will require chest tube re-insertion or not. Routine CXR after chest tube removal also leads to prolonged hospital stay.
RESUMEN
Bronchiectasis is a well-known entity where the airways abnormally dilate losing their natural function. Most common causes of non-cytic fibrosis bronchiectasis in the middle age group include secondary immunodeficiency, aspiration, and allergic bronchopulmonary aspergillosis (ABPA). Obstructive foreign body is an uncommon cause of bronchiectasis and is often a missed diagnosis in a localized disease. Foreign bodies can be missed making the diagnosis and treatment more challenging and hence foreign body bronchiectasis should be considered in patients presenting with focal disease. Here we describe a patient with a retained foreign body that was discovered post lobectomy during gross pathological examination of the specimen with no significant aspiration history, non-diagnostic imaging of the chest and negative bronchoscopy.
