Progressive iatrogenic pneumothorax from incorrectly connected Heimlich valve

Follow up chest Xx-ray to assess pneumothorax.

On physical exam hyper-resonance of the left lung field was noted when compared to the right, with no lung sounds auscultated on the left side when compared to the right side.  

The patient's pigtail catheter was also examined at this time; the Heimlich valve was noted to be placed in reverse with the pigtail catheter obstructed, therefore preventing gas from escaping.  

The Heimlich valve was re-connectedreconnected to the chest drainage set withand wall suction with gas bubbles present after connection.

1. CXR: Iatrogenic pneumothorax fromsecondary to insertion of a port placement.
2. CXR: Placement of chest tube with resolution of the pneumothorax.

   Iatrogenic

3. CXR: 24 hours follow up: iatrogenic tension pneumothorax fromwith complete left lung collapse, from erroneous attachment of the Heimlich valve to the chest tube.
4. CXR: Resolution of tension pneumothorax after reversing the one-way valve back to its correct orientation

In this case, the cause cannot be seen on the Xx-ray. Examination of the chest tube set-up demonstrated that the Heimlich valve had been connected the wrong way.

Blue end.