Progressive iatrogenic pneumothorax from incorrectly connected Heimlich valve

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Follow up chest x-ray to assess pneumothorax.

Patient Data

Age: 60 years
Gender: Female
  1. CXR: Iatrogenic pneumothorax secondary to insertion of a port.
  2. CXR: Placement of chest tube with resolution of the pneumothorax.
  3. CXR: 24 hours follow up: iatrogenic tension pneumothorax with 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.

Blue-colored end of the Heimlich valve attaches to the tube coming from the patient.

Case Discussion

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.

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