A 56 yo asthmatic presents in cardiac arrest.  During resuscitation she has bilateral needle decompression and subsequent bilateral thoracostomy tube placement.  She has a post-ROSC chest film obtained.  What's the diagnosis?  (Scroll down for answer)

Answer:  Dislodged right thoracostomy tube (see below image)

• Thoracostomy tubes must be advanced far enough into the thoracic cavity so that the most distal portal lies within the pleural space.
• In this film the right tube's last hole lies outside of the pleural space. This could be the result of insufficient advancement during the procedure or failure to secure an appropriately advanced tube.
• Post-procedureal x-ray is always used to confirm placement.
• The tube should not be advanced further into the chest cavity...this would be advancing a non-sterile tube into a sterile cavity...a new chest tube must be placed.
• Read more on thoracostomy tubes.