S. Bockhorst, V. Dayaram, H. Jones, B. Glaenzer, S. Contractor
Purpose: Interventional radiologists must be familiar with the various complications of chest procedures and how to manage those complications.
Material and Methods: Most institutions monitor patients with continuous oxygen saturation and obtain a chest radiograph at 1 and 3 hours following the procedure to evaluate for pneumothorax. This complication generally presents as acute dyspnea and pleuritic chest pain. Asymptomatic patients with small pneumothoraxes can be observed, whereas symptomatic patients or large pneumothoraces require chest tube thoracostomy.
Bleeding complications should be suspected if patients become unstable and have rapid reaccumulation of fluid within the pleura or soft tissue spaces. Many medications (warfarin, heparin, clopidogrel) or physiological factors (elevated International Normalized Ratio, thrombocytopenia, uremia) increase the risk for bleeding. Frequently these medications are withheld or transfusions are performed to normalize physiological parameters before a procedure. Management by placement of chest tube alone depends on hemodynamic stability, the volume of evacuated blood, and the occurrence of persistent blood loss. If conservative treatment is insufficient, a surgical approach is indicated to prevent subsequent complications.
The true incidence of air embolism may never be known, and many cases are subclinical. Large air embolisms can lodge into the heart or vessels and occlude blood flow which can present as tachyarrhythmias, chest pain, coughing, dyspnea, hypoxemia, and cardiovascular collapse. If this complication is suspected, placing the patient in Trendelenburg and left lateral decubitus position can trap the air embolism in the right heart and prevent further complications. These patients require supportive treatment including fluids and 100% oxygen.
Re-expansion pulmonary edema is a rare but a potentially fatal complication that presents similarly to air embolism complication. To reduce the risk of this complication, guidelines recommend draining less than 1.5 liters of pleural fluid at a time. Treatment is generally supportive with oxygen supplementation and ventilation.
Results: In our case series only the re-expansion pulmonary edema case resulted in mortality. Patients with complications in the other categories responded to standard management and were promptly discharged.
Conclusions: Pneumothorax, bleeding, air embolism and re-expansion pulmonary edema complications can be successfully managed.