Iatrogenic Insertion of Chest Tube inside the Right Pulmonary Artery: Unique, Unheard Complication, and Management

A 75-year-old male patient referred from a medical college for emergency surgical removal of chest tube from the right pulmonary artery, inserted while treating a right-sided pneumothorax. The patient was a known case of COVID pneumonia treated successfully, 2 months back. The patient developed sudden breathlessness and chest pain with saturation of 70%. The patient had gone to nearest medical college for evaluation. Chest X-ray showed right-sided pneumothorax. Chest physician inserted intercostal chest tube. After insertion of chest tube, the patient drained 1500 ml of frank blood. Chest tube clamped and referred to a tertiary care center. Emergency computed tomography (CT) pulmonary angiogram is done. It showed chest tube tip in the right pulmonary artery. In view of post-COVID, severe interstitial lung disease, patient was not suitable for open heart surgery with the support of heart-lung machine. The patient was stable when we were received; saturation was 90% with 5 L oxygen. CT chest showed diffuse fibrosis and resolving pneumonia. Echo showed severe pulmonary arterial hypertension. We did high-risk off- pump right thoracotomy and removed chest tube without much loss of blood. The injured right pulmonary artery repaired. Post-operative period was free of events and discharged successfully. In complicated cases, preferably thoracic surgeon and a well-trained, experienced chest physician should insert chest tube to avoid life-threatening complications.

Occult hemoptysis: a rare case of esthesioneuroblastoma

<p>Esthesioneuroblastoma forms a part of the spectrum of rare malignancies of the olfactory neuroepitheliem. The rarity of the tumour precludes systematic approach to clinical diagnosis and management. This study involves a case of 68 years old female who presents with chief complaints of hemoptysis for 3 months in the medical outpatient department with no nasal signs and symptoms. After referral to chest physician she is referred for ear nose and throat opinion. Esthesioneuroblastoma presentation is very varied and the case reports published have been very few. In view of the rarity of the tumour, clinical suspicion is essential in unusual presentation of hemoptysis.</p>