Table 2.
Clinical details of patients not responding to initial pigtail catheter placement (therapeutic failures).
| Pneumothoraces: | ||
|---|---|---|
| Pt.# | History | Resolution |
| 1 | s/p lung transplant, OB, PTX after TBBx | Persistent PTX after 72 hours, resolved with CT |
| 2 | s/p OLTX, diffuse pulmonary abscesses | Ongoing air leak/PTX at 48 hours, 2nd pigtail unsuccessful, 2 Cts placed: persistent air leak; ARDS, death |
| 3 | advanced COPD, pneumonia, PTX after central line | Persistent PTX/air leak at 48 hours; required 3 Cts / 19 days to resolve PTX |
| 4 | anorectal cancer, PTX after central line placement | Initial success; recurrent PTX at 96 hours (pigtail sideholes migrated outside thorax); resolved with CT |
| 5 | 3 days s/p CABG; bilat PTX after CT removal | Left pigtail successful; right pigtail failed; CT successful |
| Effusions: | ||
| 1 | 13 days s/p CABG; nonlayering effusion | Pigtail # drained 550 cc/24hrs, then displaced to chest wall Pigtail #2: minimal drainage; CT & CAT-guided pigtail successful |
| 2 | 29 days s/p OLTX | Pigtail successful, removed with 1 liter/day output; 2nd pigtail successful |
| 3 | metastatic breast cancer: bilateral effusions | Left pigtail successful; Right failed: loculated collection required ultrasound-guided drainage w/ 8F catheter |
| 4 | 10 days s/p OLTX | Effusion drained: persistent air leak resolved with 2nd pigtail |
| 5 | 1 day s/p OLTX: opacified hemithorax | Minimal drainage with pigtail; CT also failed: thoracotomy for large hemothorax |
| 6 | 11 days s/p OLTX: right effusion | Pigtail sideholes extrapleural; CT unsuccessful; U/S guided thoracentesis fails: death from sepsis |
| 7 | 14 days s/p AVR: R effusion | Effusion resolved with pigtail: removed 48 hours after placement; pneumothorax 24 hours later resolved w/ CT |
| 8 | 1 month s/p hepatic lobectomy: R effusion | U/S catheter drainage failed; pigtail->partial drainage; CAT-guided 10F catheters x 2 failed (loculated collection); VATS successful |
| 9 | 2 years s/p OLTX: R effusion | Pigtail successful × 72 hours: pulled out on bedrail; residual fluid removed with thoracentesis |
| 10 | Ascites (ESLD): R effusion | Pigtail successful, removed with 1600 cc/day output; second pigtail successful |
OB = obliterative bronchiolitis PTX = pneumothorax TBBx = trans-bronchial biopsy ESLD = end-stage liver disease CT = chest tube OLTX = orthotopic liver transplant ARDS = adult respiratory distress syndrome COPD = chronic obstructive pulmonary disease CABG = coronary artery bypass grafting CAT = computed tomography AVR = aortic valve replacement U/S = ultrasound VATS = video-assisted thoracoscopic surgery