Tension pneumothorax and pneumomediastinum caused by a malpositioned mediastinal drain in a patient following closure of an atrial septal defect

Abstract

M EDIASTINAL AND pleural drains are inserted after cardiac surgery to evacuate the postoperative bleeding, fluids, and air from the mediastinum or pleural cavity. These drains usually are removed as soon as the bleeding is minimal and cardiac and respiratory functions are stable. Even though the incidence of pneumothorax after cardiac surgical proce- dures in adults1-3 is low (1.4%-3%), a slightly higher incidence (13.6%) has been reported in pediatric patients.4 Most of these cases are clinically identifiable. A case of a malpositioned mediastinal drain causing pneumothorax has not been reported. An 8-year-old boy who underwent surgical closure of an atrial septal defect and developed a right tension pneumothorax and pneumomediastinum postoperatively in the presence of a func- tioning pleural drain because of the malpositioned mediastinal drain is presented.