Vascular plug sealing chest tube liver tract.

When Chest Tubes Go Wrong: A Simple Plug Can Save the Day

Avery Sinclair in Health & Wellness August 2025 • 4 min read.

"Learn how a common vascular plug can effectively resolve accidental chest tube placements in the liver, preventing severe complications."

Medical procedures, while intended to heal, occasionally take unforeseen turns. One such complication arises when inserting a chest tube, a common procedure to drain fluid or air from the chest cavity. In rare instances, the tube can be misdirected, entering organs like the liver, leading to significant bleeding and potentially life-threatening situations.

A recent case highlighted by Hamanaka et al. [1] underscores this challenge, prompting physicians to share similar experiences and innovative solutions. One such solution involves the use of Amplatzer Vascular Plugs (AVP), typically used to block blood vessels, to seal off the accidental tract created by the misplaced chest tube.

This approach offers a minimally invasive way to stop the bleeding and stabilize the patient, avoiding more complex surgical interventions. This article explores how AVPs are used in these emergency situations, providing insights into the procedure, its benefits, and considerations for patient care.

The Case of the Misplaced Chest Tube: A Bleeding Emergency

Vascular plug sealing chest tube liver tract.

Consider the case of a 70-year-old man presenting with dyspnea (shortness of breath). Initial diagnostics, including a computed tomography (CT) scan, revealed a mass in the right lung that appeared to be invading the chest wall. The patient also had a collapsed right upper lobe and a pleural effusion (fluid accumulation in the chest cavity).

To drain the fluid, a chest tube was inserted. However, instead of draining fluid, a significant surge of blood (approximately 550 mL) occurred immediately after insertion. This dire event triggered cardiopulmonary resuscitation to stabilize the patient. Subsequent imaging revealed that the chest tube had been misdirected, penetrating the liver and traveling through the right hepatic vein, ultimately reaching the right ventricle of the heart.

The Challenge: Misplaced chest tubes can cause severe bleeding and require immediate intervention.
The Solution: Interventional radiologists are using Amplatzer Vascular Plugs (AVP) to embolize the errant chest tube tract in the liver.
The Outcome: This minimally invasive approach quickly stops bleeding and stabilizes the patient.

Two days later, the patient was referred to interventional radiology for removal of the chest tube and embolization (blocking) of the liver tract. The interventional radiology team carefully withdrew the chest tube under fluoroscopic guidance, using vertebral contours as landmarks to navigate. Once the tube was pulled back to the inferior vena cava (IVC), a guidewire and catheter were advanced through the chest tube into the hepatic vein. Finally, an AVP was deployed to block the tract.

AVP: A Safe and Effective Solution

In summary, the use of Amplatzer Vascular Plugs appears to be a safe and effective method for embolizing errant tracts created by malpositioned chest tubes. While this technique offers a promising solution, it's crucial to consider individual patient factors. Patients with hepatic congestion, for instance, might benefit more from an occlusive balloon technique. Further research and clinical experience will continue to refine and optimize the use of AVPs in these challenging situations, ultimately improving patient safety and outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is the main problem when a chest tube goes wrong, and what is the solution?

The primary concern when a chest tube is misplaced is severe bleeding, potentially leading to life-threatening complications. Interventional radiologists address this issue by using Amplatzer Vascular Plugs (AVP) to embolize the errant tract in the liver. This minimally invasive procedure aims to quickly stop the bleeding and stabilize the patient, offering an alternative to more invasive surgical options.

How does the Amplatzer Vascular Plug (AVP) work in the context of a misplaced chest tube, and what are its benefits?

The Amplatzer Vascular Plug (AVP) is used to block the tract created by a misplaced chest tube. In the example case, after the tube was removed, the interventional radiology team inserted a guidewire and catheter to reach the hepatic vein. Then, the AVP was deployed to occlude the tract. This approach is minimally invasive, effectively stopping the bleeding and stabilizing the patient. The main benefit is a safer and faster resolution compared to surgical interventions.

Can you explain a real-world scenario where a chest tube misplacement caused complications, and what steps were taken to resolve it?

In one instance, a 70-year-old man with a lung mass and pleural effusion received a chest tube. Unfortunately, the tube penetrated the liver and right hepatic vein, leading to significant bleeding and cardiopulmonary resuscitation. The interventional radiology team then withdrew the chest tube and used an Amplatzer Vascular Plug (AVP) to block the tract in the liver. This stopped the bleeding and helped to stabilize the patient.

What are the potential risks and considerations when using Amplatzer Vascular Plugs (AVP) for misplaced chest tubes, and are there alternative treatments?

While Amplatzer Vascular Plugs (AVP) are generally safe and effective, healthcare professionals must consider individual patient factors. For example, patients with hepatic congestion might benefit more from an occlusive balloon technique. Further research and clinical experience are essential for optimizing the use of AVPs and improving patient outcomes in these challenging situations.

What is the role of interventional radiology in addressing complications from misplaced chest tubes, and how does it improve patient outcomes?

Interventional radiologists play a crucial role in treating complications arising from misplaced chest tubes. They use imaging guidance to diagnose and treat the issue. In the given scenario, they used the Amplatzer Vascular Plugs (AVP) to embolize the errant chest tube tract. This minimally invasive approach quickly stops bleeding and stabilizes the patient, potentially preventing more complex surgical interventions and improving overall patient outcomes.