Ultrasound-guided retrieval of the retained broken intercostal chest tube: A case report

Ultrasound-guided retrieval of the retained broken intercostal chest tube: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Ultrasound-guided retrieval of the retained broken intercostal chest tube: A case report Vaibhav Aggarwal, Muhammed Huzaifa, Ankita Singh, Piyush Ranjan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7168090/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Foreign bodies in the pleural cavity are uncommon and usually a result of chest wall trauma. Retained ICD tubes in the intrapleural space are unusual and rare and warrant urgent surgical intervention (VATS or thoracotomy) to avoid complications. The role of point of care ultrasound as an adjunct in the localization and removal of such foreign bodies has been poorly evaluated. Case presentation: We report a case of a middle-aged gentleman with the carcinoma lung associated with malignant pleural effusion. This was complicated by a retained intrapleural ICD tube. We used point of care ultrasound to localise and remove it bedside under local anaesthesia. Conclusions: This case emphasizes the role of the point of care ultrasound as the fast, cost-effective and feasible alternative for bedside localisation and removal of intrapleural foreign bodies. Clinicians should be aware of the retained tubes as a potential complication of the tube thoracostomy. Adequate analgesia, patient education and interdisciplinary teamwork may help prevent such incidents in future. thoracostomy tube retained catheter point of care ultrasound intrapleural foreign body ultrasound-guided retrieval Figures Figure 1 Figure 2 Figure 3 Background Tube thoracostomy or intercostal drainage (ICD) tube insertion is a commonly performed surgical procedure while dealing with chest pathologies such as pleural effusions, pneumothorax, empyema or haemorrhage. However, these tubes could be a source of significant patient’s pain and discomfort( 1 ). In addition, it is associated with significant complications, some are very morbid and maybe lethal( 2 ). Foreign bodies in the pleural cavity are uncommon and usually a result of chest wall trauma. Retained ICD tubes in the intrapleural space are unusual and rare and warrant urgent surgical intervention (VATS or thoracotomy) to avoid complications. The role of point of care ultrasound as an adjunct in the localization and removal of such foreign bodies has been poorly evaluated. Here we report a case of a middle-aged gentleman complicated by a retained intrapleural ICD tube in which POCUS was used to localise and remove it bedside under local anaesthesia. Case presentation A 42-year-old gentleman with the diagnosis of metastatic carcinoma of the left lung (performance status ECOG-4) presented with a 6 weeks history of cough and breathlessness. Chest x-ray revealed a massive left-sided malignant pleural effusion for which an ICD tube was put. The correct position of the tube was confirmed with the post-insertion chest X-ray. Post insertion, due to persistent chest discomfort due to the ICD tube, the patient intentionally cut the tube along the chest wall using a knife. As a result, the proximal end of the tube migrated completely inside the pleural cavity. On a repeat physical exam, the patient developed tachycardia and tachypnoea. Air entry on the left side of the chest was decreased. A bedside chest X-ray demonstrated left pleural effusion and retained portion of tube (Fig. 1 ). A 28 F chest tube was inserted into the fifth intercostal space in the midaxillary line from the site of the previous tube insertion to relieve symptoms due to pleural effusion. A repeat chest X-ray revealed the correct position of the newly inserted ICD tube and the presence of the retained tube whose one end lay close to the parietal pleura in the midclavicular line (Fig. 2 ). We planned a chest CT for this patient. However, in view of sudden deterioration and hemodynamic instability, a decision was taken not to shift the patient for a CT and bedside ultrasound-guided retrieval of the retained tube under local anaesthesia was planned. This was explained to the patient and the next of kin. However, the challenge here was to determine the exact position of the tube’s end. We used bedside ultrasound to localise it in the fifth intercostal space in the midclavicular line. We kept the backup of the thoracic surgeon and Video-Assisted thoracoscopic surgery (VATS) equipment ready in the OR to be used if needed. Local anaesthesia was infiltrated in the anterior chest at the left fifth intercostal space and a 3 cm (mini-thoracotomy) incision was made. The end of the ICD tube was visualised and pulled out. The length of the tube removed was 12 cm. Chest X-ray confirmed complete removal of the foreign body (Fig. 3 ). Over a few days, the clinical condition of the patient gradually improved and was shifted to the medical oncology unit for chemotherapy. Discussion Tube thoracostomy is a common surgical procedure used for treating several thoracic conditions. Nonetheless, this procedure does have complications with a median incidence of 19% in trauma patients( 3 ). These could be related to insertion, position, removal, infection and malfunction of the tube. “Bundle of care” for ICD tube insertion is important to minimise such complications. It includes the proper technique of insertion and removal, monitoring chest tube position, controlling fluid evacuation, regular monitoring of water column for early detection of the blockade in a tube, care during changing or emptying the container and care of the tube and the drainage system while transportation( 4 ). Retained broken ICD tube in the intrapleural cavity is an exceedingly rare phenomenon. A few such cases have been described in the literature which occurred due to difficult insertion and negligent removal of the chest tube( 5 , 6 ). Others have described cases where drainage catheters were retained in the pleural cavity due to excessive kinking or shearing leading to the fracture of catheters( 7 – 9 ). In our case, the retained ICD tube was due to intentional damage to the tube by the patient, triggered by pain and discomfort at the local site. Akutay et al. in a study of 102 patients showed that pain severity scores post thoracostomy tube insertion and on the first day were very high and this negatively affected the sleep quality( 10 ). Moreover, constant chest discomfort or pain restricts adequate chest movement and impairs pulmonary function which may negatively affect the outcomes. It is therefore important for the healthcare staff to be aware of the importance of adequate analgesia and patient counselling in tube thoracostomy care. A recent systematic review by Ghazali et al.( 11 ) found divergence in performing tube thoracostomies among studies and a lack of standardized protocols to teach tube thoracostomy care to medical students and residents. The authors emphasized the role of interdisciplinary teamwork and patient education in tube thoracostomy care. Infiltration of the local anaesthetic agent while insertion, use of regional anaesthetic, topical anaesthetic agent and use of WHO pain ladder after insertion has been shown to improve pain in patients with tube thoracostomy( 1 ). Implementation and institutional adoption of the procedural pain management guideline could be effective in this regard( 12 ). Most thoracic radiological investigations involve the use of Chest X-ray or CT. However, there has been an increased interest in POCUS of the lung in rapid and reliable assessment in critically ill patients. POCUS is commonly used to diagnose pneumothorax, pneumonia, atelectasis and pleural effusions and is sometimes used for radiologically guided procedures as well to manage such conditions( 13 ). More recently, a systematic review by Menegozzo et al.( 14 ) showed that POCUS may be a useful adjunct in performing tube thoracostomy to identify the intercostal artery, localize intercostal space and confirm the tube position. It may potentially replace the chest x-ray for confirming tube placement( 15 ). However, the role of bedside ultrasound for assessment and removal of intrapleural foreign bodies including retained catheters has not been evaluated sufficiently. Narasimhan et al.( 16 ) used bedside ultrasound to localise the broken thoracentesis needle in the pleural cavity and removed it using thoracoscopy. Sumalani et al.( 8 ) described a case where they used POCUS to mark the entry site of a thoracoscope for removal of the broken pleural catheter under local anaesthesia. We believe that bedside ultrasound could be an acceptable alternative to the chest x-ray or CT chest for fast and real-time assessment of intrapleural foreign bodies in select patients who are critically ill. However, the visualisation with ultrasound may be limited for objects that are deep seated and small. Conclusions This case emphasizes the role of the point of care ultrasound as the fast, cost-effective and feasible alternative for bedside localisation and removal of intrapleural foreign bodies such as retained ICD tubes, especially in frail patients. We also tend to alert clinicians of retained tubes as a potential complication of the tube thoracostomy. Adequate analgesia, patient education and interdisciplinary teamwork may help prevent such incidents in future. Abbreviations ICD – Intercostal drainage VATS - Video-Assisted thoracoscopic surgery CT – Computed Tomography Declarations Ethics approval and consent to participate: Not applicable Consent for publication: written informed consent to publish was obtained from the patient Funding: No funding was obtained for this study Code availability: The code used for data processing and figure generation in this case report is available from the corresponding author upon reasonable request. Author Contribution A.S. and P.R. conceived the idea, M.H. and V.A. wrote the main manuscript, P.R. reviewed the manuscript. all authors have read and approved the manuscript Acknowledgements: Not applicable Availability of data and material: not applicable Competing interests: The authors declare that they have no competing interests References Pain Management in Patients with a Chest Drain | SpringerLink [Internet]. [cited 2022 Jan 17]. Available from: https://link.springer.com/chapter/ 10.1007/978-3-319-32339-8_10#citeas Kong VY, Clarke DL. The spectrum of visceral injuries secondary to misplaced intercostal chest drains: experience from a high volume trauma service in South Africa. Injury. 2014;45(9):1435–9. Hernandez MC, El Khatib M, Prokop L, Zielinski MD, Aho JM. Complications in tube thoracostomy: Systematic review and meta-analysis. J Trauma Acute Care Surg. 2018;85(2):410–6. Durai R, Hoque H, Davies TW. Managing a chest tube and drainage system. AORN J. 2010;91(2):275–80; quiz 281–3. Weissberg D, Weissberg-Kasav D. Foreign Bodies in Pleura and Chest Wall. Ann Thorac Surg. 2008;86(3):958–61. Oswald NK, Abdelaziz M, Rajesh PB, Steyn RS. A case of a retained drain tip following intercostal drain insertion: avoiding a ‘never event.’ J Surg Case Rep. 2016;2016(4):rjw055. Waqanivavalagi SWFR, Chaudhuri K. A case of a retained chest drain. J Surg Case Rep. 2021;2021(3):rjab049. Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, Sumalani KK, Rehman U, Department of Ear Nose and Throat (ENT), Jinnah Postgraduate Medical Center, Karachi, Pakistan, Akhter N, Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, et al. Use of Medical Thoracoscopy for Retrieval of Broken Intrapleural Catheter. Turk Thorac J. 2021;22(2):179–81. Paddle A, Elahi M, Newcomb A. Retained foreign body following pleural drainage with a small-bore catheter. Gen Thorac Cardiovasc Surg. 2010;58(1):42–4. Akutay S, Yilmaz M. The relationship between pain severity and sleep quality: Posttube thoracostomy. Nurs Forum (Auckl). 2021;56(4):860–8. Ghazali D, Ilha-Schuelter P, Barbosa S, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456–65. Ring LM, Watson A. Thoracostomy Tube Removal: Implementation of a Multidisciplinary Procedural Pain Management Guideline. J Pediatr Health Care. 2017;31(6):671–83. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. Am J Respir Crit Care Med. 2019;199(6):701–14. Menegozzo CAM, Artifon ELA, Meyer-Pflug AR, Rocha MC, Utiyama EM. Can ultrasound be used as an adjunct for tube thoracostomy? A systematic review of potential application to reduce procedure-related complications. Int J Surg. 2019;68:85–90. Jenkins JA, Gharahbaghian L, Doniger SJ, Bradley S, Crandall S, Spain DA, et al. Sonographic Identification of Tube Thoracostomy Study (SITTS): Confirmation of Intrathoracic Placement. West J Emerg Med. 2012;13(4):305–11. Narasimhan RL, Sehgal IS, Dhooria S, Aggarwal AN, Behera D, Agarwal R. Removal of Intrapleural Foreign Body by Medical Thoracoscopy: Report of Two Cases and a Systematic Review of the Literature. J Bronchol Interv Pulmonol. 2017;24(3):244–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7168090","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":489853767,"identity":"cb56f2c5-4754-4370-bb4c-4abc989fa952","order_by":0,"name":"Vaibhav 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07:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7168090/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7168090/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87576242,"identity":"63bb6389-b74b-40ee-ad8c-e6ebfc1047d6","added_by":"auto","created_at":"2025-07-25 11:41:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79684,"visible":true,"origin":"","legend":"\u003cp\u003eChest X-ray demonstrates left hydrothorax and retained portion of ICD tube.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7168090/v1/e827442daf46d438132cad2f.jpg"},{"id":87576241,"identity":"9a159613-d96b-44bd-8463-dd93800cad48","added_by":"auto","created_at":"2025-07-25 11:41:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55510,"visible":true,"origin":"","legend":"\u003cp\u003eChest x-ray A) Antero-posterior and B) lateral views showing retained ICD tube (narrow arrow) and newly inserted ICD tube (broad arrow).\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7168090/v1/0fe3810e0a48922a2bda5e86.jpg"},{"id":87577064,"identity":"7c542976-179e-4cde-87ae-2c690dd8f068","added_by":"auto","created_at":"2025-07-25 11:49:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":64049,"visible":true,"origin":"","legend":"\u003cp\u003eA) Retained ICD tube being retrieved after localization using ultrasound (arrow), B) Chest X-ray demonstrates complete removal of the retained ICD tube.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7168090/v1/2f3ae5850e8a91b53e15a771.jpg"},{"id":87896672,"identity":"06c9104b-4f43-4916-aec9-cdcc4d6f1ddb","added_by":"auto","created_at":"2025-07-30 07:39:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":560633,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7168090/v1/cbed8ec9-1a6e-4b3d-bc53-c01ac1587135.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ultrasound-guided retrieval of the retained broken intercostal chest tube: A case report","fulltext":[{"header":"Background","content":"\u003cp\u003eTube thoracostomy or intercostal drainage (ICD) tube insertion is a commonly performed surgical procedure while dealing with chest pathologies such as pleural effusions, pneumothorax, empyema or haemorrhage. However, these tubes could be a source of significant patient’s pain and discomfort(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In addition, it is associated with significant complications, some are very morbid and maybe lethal(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eForeign bodies in the pleural cavity are uncommon and usually a result of chest wall trauma. Retained ICD tubes in the intrapleural space are unusual and rare and warrant urgent surgical intervention (VATS or thoracotomy) to avoid complications. The role of point of care ultrasound as an adjunct in the localization and removal of such foreign bodies has been poorly evaluated.\u003c/p\u003e\u003cp\u003eHere we report a case of a middle-aged gentleman complicated by a retained intrapleural ICD tube in which POCUS was used to localise and remove it bedside under local anaesthesia.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 42-year-old gentleman with the diagnosis of metastatic carcinoma of the left lung (performance status ECOG-4) presented with a 6 weeks history of cough and breathlessness. Chest x-ray revealed a massive left-sided malignant pleural effusion for which an ICD tube was put. The correct position of the tube was confirmed with the post-insertion chest X-ray. Post insertion, due to persistent chest discomfort due to the ICD tube, the patient intentionally cut the tube along the chest wall using a knife. As a result, the proximal end of the tube migrated completely inside the pleural cavity.\u003c/p\u003e\u003cp\u003eOn a repeat physical exam, the patient developed tachycardia and tachypnoea. Air entry on the left side of the chest was decreased. A bedside chest X-ray demonstrated left pleural effusion and retained portion of tube (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A 28 F chest tube was inserted into the fifth intercostal space in the midaxillary line from the site of the previous tube insertion to relieve symptoms due to pleural effusion. A repeat chest X-ray revealed the correct position of the newly inserted ICD tube and the presence of the retained tube whose one end lay close to the parietal pleura in the midclavicular line (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We planned a chest CT for this patient. However, in view of sudden deterioration and hemodynamic instability, a decision was taken not to shift the patient for a CT and bedside ultrasound-guided retrieval of the retained tube under local anaesthesia was planned. This was explained to the patient and the next of kin. However, the challenge here was to determine the exact position of the tube’s end. We used bedside ultrasound to localise it in the fifth intercostal space in the midclavicular line. We kept the backup of the thoracic surgeon and Video-Assisted thoracoscopic surgery (VATS) equipment ready in the OR to be used if needed.\u003c/p\u003e\u003cp\u003eLocal anaesthesia was infiltrated in the anterior chest at the left fifth intercostal space and a 3 cm (mini-thoracotomy) incision was made. The end of the ICD tube was visualised and pulled out. The length of the tube removed was 12 cm. Chest X-ray confirmed complete removal of the foreign body (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Over a few days, the clinical condition of the patient gradually improved and was shifted to the medical oncology unit for chemotherapy.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTube thoracostomy is a common surgical procedure used for treating several thoracic conditions. Nonetheless, this procedure does have complications with a median incidence of 19% in trauma patients(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These could be related to insertion, position, removal, infection and malfunction of the tube. \u0026ldquo;Bundle of care\u0026rdquo; for ICD tube insertion is important to minimise such complications. It includes the proper technique of insertion and removal, monitoring chest tube position, controlling fluid evacuation, regular monitoring of water column for early detection of the blockade in a tube, care during changing or emptying the container and care of the tube and the drainage system while transportation(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRetained broken ICD tube in the intrapleural cavity is an exceedingly rare phenomenon. A few such cases have been described in the literature which occurred due to difficult insertion and negligent removal of the chest tube(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Others have described cases where drainage catheters were retained in the pleural cavity due to excessive kinking or shearing leading to the fracture of catheters(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In our case, the retained ICD tube was due to intentional damage to the tube by the patient, triggered by pain and discomfort at the local site. Akutay et al. in a study of 102 patients showed that pain severity scores post thoracostomy tube insertion and on the first day were very high and this negatively affected the sleep quality(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Moreover, constant chest discomfort or pain restricts adequate chest movement and impairs pulmonary function which may negatively affect the outcomes. It is therefore important for the healthcare staff to be aware of the importance of adequate analgesia and patient counselling in tube thoracostomy care. A recent systematic review by Ghazali et al.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) found divergence in performing tube thoracostomies among studies and a lack of standardized protocols to teach tube thoracostomy care to medical students and residents. The authors emphasized the role of interdisciplinary teamwork and patient education in tube thoracostomy care. Infiltration of the local anaesthetic agent while insertion, use of regional anaesthetic, topical anaesthetic agent and use of WHO pain ladder after insertion has been shown to improve pain in patients with tube thoracostomy(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Implementation and institutional adoption of the procedural pain management guideline could be effective in this regard(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost thoracic radiological investigations involve the use of Chest X-ray or CT. However, there has been an increased interest in POCUS of the lung in rapid and reliable assessment in critically ill patients. POCUS is commonly used to diagnose pneumothorax, pneumonia, atelectasis and pleural effusions and is sometimes used for radiologically guided procedures as well to manage such conditions(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). More recently, a systematic review by Menegozzo et al.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) showed that POCUS may be a useful adjunct in performing tube thoracostomy to identify the intercostal artery, localize intercostal space and confirm the tube position. It may potentially replace the chest x-ray for confirming tube placement(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, the role of bedside ultrasound for assessment and removal of intrapleural foreign bodies including retained catheters has not been evaluated sufficiently. Narasimhan et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) used bedside ultrasound to localise the broken thoracentesis needle in the pleural cavity and removed it using thoracoscopy. Sumalani et al.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) described a case where they used POCUS to mark the entry site of a thoracoscope for removal of the broken pleural catheter under local anaesthesia. We believe that bedside ultrasound could be an acceptable alternative to the chest x-ray or CT chest for fast and real-time assessment of intrapleural foreign bodies in select patients who are critically ill. However, the visualisation with ultrasound may be limited for objects that are deep seated and small.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis case emphasizes the role of the point of care ultrasound as the fast, cost-effective and feasible alternative for bedside localisation and removal of intrapleural foreign bodies such as retained ICD tubes, especially in frail patients. We also tend to alert clinicians of retained tubes as a potential complication of the tube thoracostomy. Adequate analgesia, patient education and interdisciplinary teamwork may help prevent such incidents in future.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eICD \u0026ndash; Intercostal drainage\u003c/p\u003e\n\u003cp\u003eVATS -\u0026nbsp;Video-Assisted thoracoscopic surgery\u003c/p\u003e\n\u003cp\u003eCT \u0026ndash; Computed Tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewritten informed consent to publish was obtained from the patient\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability: \u003c/strong\u003eThe code used for data processing and figure generation in this case report is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.S. and P.R. conceived the idea, M.H. and V.A. wrote the main manuscript, P.R. reviewed the manuscript. all authors have read and approved the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePain Management in Patients with a Chest Drain | SpringerLink [Internet]. [cited 2022 Jan 17]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/chapter/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/chapter/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-3-319-32339-8_10#citeas\u003c/span\u003e\u003cspan address=\"10.1007/978-3-319-32339-8_10#citeas\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKong VY, Clarke DL. The spectrum of visceral injuries secondary to misplaced intercostal chest drains: experience from a high volume trauma service in South Africa. Injury. 2014;45(9):1435\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHernandez MC, El Khatib M, Prokop L, Zielinski MD, Aho JM. Complications in tube thoracostomy: Systematic review and meta-analysis. J Trauma Acute Care Surg. 2018;85(2):410\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDurai R, Hoque H, Davies TW. Managing a chest tube and drainage system. AORN J. 2010;91(2):275\u0026ndash;80; quiz 281\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeissberg D, Weissberg-Kasav D. Foreign Bodies in Pleura and Chest Wall. Ann Thorac Surg. 2008;86(3):958\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOswald NK, Abdelaziz M, Rajesh PB, Steyn RS. A case of a retained drain tip following intercostal drain insertion: avoiding a \u0026lsquo;never event.\u0026rsquo; J Surg Case Rep. 2016;2016(4):rjw055.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaqanivavalagi SWFR, Chaudhuri K. A case of a retained chest drain. J Surg Case Rep. 2021;2021(3):rjab049.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepartment of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, Sumalani KK, Rehman U, Department of Ear Nose and Throat (ENT), Jinnah Postgraduate Medical Center, Karachi, Pakistan, Akhter N, Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, et al. Use of Medical Thoracoscopy for Retrieval of Broken Intrapleural Catheter. Turk Thorac J. 2021;22(2):179\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaddle A, Elahi M, Newcomb A. Retained foreign body following pleural drainage with a small-bore catheter. Gen Thorac Cardiovasc Surg. 2010;58(1):42\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkutay S, Yilmaz M. The relationship between pain severity and sleep quality: Posttube thoracostomy. Nurs Forum (Auckl). 2021;56(4):860\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhazali D, Ilha-Schuelter P, Barbosa S, Truchot J, Ceccaldi P, Tourinho F, et al. Interdisciplinary teamwork for chest tube insertion and management: an integrative review. Anaesthesiol Intensive Ther. 2021;53(5):456\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRing LM, Watson A. Thoracostomy Tube Removal: Implementation of a Multidisciplinary Procedural Pain Management Guideline. J Pediatr Health Care. 2017;31(6):671\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. Am J Respir Crit Care Med. 2019;199(6):701\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMenegozzo CAM, Artifon ELA, Meyer-Pflug AR, Rocha MC, Utiyama EM. Can ultrasound be used as an adjunct for tube thoracostomy? A systematic review of potential application to reduce procedure-related complications. Int J Surg. 2019;68:85\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJenkins JA, Gharahbaghian L, Doniger SJ, Bradley S, Crandall S, Spain DA, et al. Sonographic Identification of Tube Thoracostomy Study (SITTS): Confirmation of Intrathoracic Placement. West J Emerg Med. 2012;13(4):305\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNarasimhan RL, Sehgal IS, Dhooria S, Aggarwal AN, Behera D, Agarwal R. Removal of Intrapleural Foreign Body by Medical Thoracoscopy: Report of Two Cases and a Systematic Review of the Literature. J Bronchol Interv Pulmonol. 2017;24(3):244\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"thoracostomy tube, retained catheter, point of care ultrasound, intrapleural foreign body, ultrasound-guided retrieval","lastPublishedDoi":"10.21203/rs.3.rs-7168090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7168090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Foreign bodies in the pleural cavity are uncommon and usually a result of chest wall trauma. Retained ICD tubes in the intrapleural space are unusual and rare and warrant urgent surgical intervention (VATS or thoracotomy) to avoid complications. The role of point of care ultrasound as an adjunct in the localization and removal of such foreign bodies has been poorly evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e We report a case of a middle-aged gentleman with the carcinoma lung associated with malignant pleural effusion. This was complicated by a retained intrapleural ICD tube. We used point of care ultrasound to localise and remove it bedside under local anaesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This case emphasizes the role of the point of care ultrasound as the fast, cost-effective and feasible alternative for bedside localisation and removal of intrapleural foreign bodies. Clinicians should be aware of the retained tubes as a potential complication of the tube thoracostomy. Adequate analgesia, patient education and interdisciplinary teamwork may help prevent such incidents in future.\u003c/p\u003e","manuscriptTitle":"Ultrasound-guided retrieval of the retained broken intercostal chest tube: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 11:41:33","doi":"10.21203/rs.3.rs-7168090/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"823c4837-8058-426a-b20a-018629b31454","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-30T07:38:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-25 11:41:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7168090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7168090","identity":"rs-7168090","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}