A letter in response to "Thoracostomy tubes: A comprehensive review of complications and related topics".

Dear Editor,

I read with interest the article titled “Thoracostomy tubes: A comprehensive review of complications and related topics”[1] in which the authors have meticulously reviewed the complications associated with tube thoracostomy. In addition to the mentioned complications I would like to add a few complications reported in relation to tube thoracostomy which though rare, still deserves special mention.

Tension pneumothorax can complicate intercostal tube drainage insertion if Heimlich's valve are improperly attached as reported by Mainini et al.,[2] as this will lead to progressive entry of air into the pleural space during inspiration while the flutter valve will prevent egress of the air during expiration

Toxicity due to the effects of local anesthetic may be encountered either due to large dose of administration or due to inadvertent systemic absorption causing ataxia, arrhythmia etc[3]

Direct mechanical injury by the intercostal tube may result in phrenic nerve,[45] long thoracic nerve[6] or ulnar neuropathy.[7]