Iatrogenic Perforation of the Pulmonary Artery by a Pleural Drain

The patient is a 63-year-old male who had undergone splenectomy and had not received pneumococcal vaccination. He was admitted to our hospital with left pneumonia and parapneumonic effusion (empyema). During the insertion of the pleural drainage tube, profuse bleeding was observed, and the tube was clamped. Chest CT (Figs. 1 and 2) showed the tube in the posterior wall of the left pulmonary artery, with no active bleeding. Using thoracotomy, the tube was observed to be perforating the pulmonary parenchyma and entering the posterior wall of the pulmonary artery, where arterial bleeding was identified after careful mobilization of the tube. Hemostasis was achieved with a tobacco pouch suture that encompassed the arterial injury from the drainage tube. The patient presented an uneventful postoperative recovery. c i r e s p . 2 0 1 4 ; 9 2 ( 8 ) : e 4 9