Progressive iatrogenic pneumothorax from incorrectly connected Heimlich valve
Diagnosis certain
Updates to Case Attributes
Body
was changed:
On physical exam hyper-resonance of the left lung 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 reconnected to the chest drainage set and wall suction with gas bubbles present after connection.
-<p>On physical exam hyper-resonance of the left lung was noted when compared to the right, with no lung sounds auscultated on the left side when compared to the right side. </p><p>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. </p><p>The Heimlich valve was reconnected to the chest drainage set and wall suction with gas bubbles present after connection.</p>- +<p>On physical exam hyper-resonance of the left lung was noted when compared to the right, with no lung sounds auscultated on the left side when compared to the right side.</p><p>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.</p><p>The Heimlich valve was reconnected to the chest drainage set and wall suction with gas bubbles present after connection.</p>
References changed:
- 1. Broder J, Fox J, Milne J, Theiling B, White A. Heimlich Valve Orientation Error Leading to Radiographic Tension Pneumothorax: Analysis of an Error and a Call for Education, Device Redesign and Regulatory Action. Emerg Med J. 2016;33(4):260-7. <a href="https://doi.org/10.1136/emermed-2015-204821">doi:10.1136/emermed-2015-204821</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26531858">Pubmed</a>
- 2. Mainini S & Johnson F. Tension Pneumothorax Complicating Small-Caliber Chest Tube Insertion. Chest. 1990;97(3):759-60. <a href="https://doi.org/10.1378/chest.97.3.759">doi:10.1378/chest.97.3.759</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/2306982">Pubmed</a>
- 3. Gogakos A, Barbetakis N, Lazaridis G et al. Heimlich Valve and Pneumothorax. Ann Transl Med. 2015;3(4):54. <a href="https://doi.org/10.3978/j.issn.2305-5839.2015.03.25">doi:10.3978/j.issn.2305-5839.2015.03.25</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25861609">Pubmed</a>
- 1. Broder JS, Fox JW, Milne J, Theiling BJ, White A. Heimlich valve orientation error leading to radiographic tension pneumothorax: analysis of an error and a call for education, device redesign and regulatory action. (2016) Emergency medicine journal : EMJ. 33 (4): 260-7. <a href="https://doi.org/10.1136/emermed-2015-204821">doi:10.1136/emermed-2015-204821</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26531858">Pubmed</a> <span class="ref_v4"></span>
- 2. Mainini SE, Johnson FE. Tension pneumothorax complicating small-caliber chest tube insertion. (1990) Chest. 97 (3): 759-60. <a href="https://www.ncbi.nlm.nih.gov/pubmed/2306982">Pubmed</a> <span class="ref_v4"></span>
- 3. Gogakos A, Gogakos BN, Gogakos LG, Gogakos PA, Gogakos KA, Gogakos LS, Gogakos BS, Gogakos MI, Gogakos KV, Gogakos KI, Gogakos PG, Gogakos KN, Gogakos TK, Gogakos RA, Gogakos TG, Gogakos ZA, Gogakos TK, Gogakos ZK, Gogakos ZP. Heimlich valve and pneumothorax. (2015) Annals of Translational Medicine. 3 (4): 54. <a href="https://doi.org/10.21037/5908">doi:10.21037/5908</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25861609">Pubmed</a> <span class="ref_v4"></span>
Updates to Quizquestion Attributes
Answer
was changed:
In this case, the cause cannot be seen on the x-ray. Examination of the chest tube set-upsetup demonstrated that the Heimlich valve had been connected the wrong way around.
Updates to Study Attributes
Findings
was changed:
- CXR: Iatrogenic pneumothorax secondary to insertion of a port.
- CXR: Placement of chest tube with resolution of the pneumothorax.
- CXR: 24 hours follow up: iatrogenic tension pneumothorax with complete left lung collapse, from erroneous attachment of the Heimlich valve to the chest tube.
- CXR: Resolution of tension pneumothorax after reversing the one-way valve back to its correct orientation.