Iatrogenic pulmonary hemorrhage related to chest drain in trauma patient

NGT is misplaced with tip in the right lower lobe. ETT appropriately positioned. Old ununited right clavicle midshaft fracture and old right sided rib fractures. Likely acute incompletely imaged right proximal humeral fracture. No hemothorax or pneumothorax. Cardiomediastinal contour and venous congestion are normal for the supine position of the patient. 

Since the trauma chest x-ray, bilateral intercostal catheters have been inserted and the nasogastric tube has been successfully placed within the stomach. The right chest drain enters the parenchyma of the right lower lobe and becomes kinked. At the site of kinking there is a large volume of active contrast extravasation due pulmonary vessel injury (vein or artery) with extensive surrounding pulmonary hemorrhage and traumatic pneumatocele. The pulmonary hemorrhage was not present on the trauma chest x-ray in keeping with iatrogenic injury related to the intra-pulmonary passage of the ICC. There is also active contrast extravasation around the right drain tube within the chest wall suggesting arterial injury at this site also.  The left intercostal catheter also appears to be partially intrapulmonary with small volume of related pulmonary hemorrhage without active contrast extravasation. Acute fractures of the right third to seventh ribs anteriorly and acute fracture of the right surgical neck of humerus. Multiple old right sided rib fractures and old right clavicle fracture.