An 18-year-old man is transferred from an outside facility for management of a pneumothorax. A 14-French pigtail catheter was placed at the outside facility, but the pneumothorax did not resolve, so a second opinion is sought. A trainee places a surgical chest tube (see radiograph below), but the pneumothorax does not resolve. The patient reports pain at the insertion site, spikes a low-grade fever and becomes tachycardic. He is hemodynamically stable and has serosanguinous fluid draining from the pleurovac, with a continuous air leak.
Which of the following is the most appropriate next step?
A. Noncontrast chest CT to evaluate location of surgical chest tube
B. Removal of surgical chest tube and placing another pigtail catheter
C. Thoracic surgery consultation for loculated pneumothorax
D. Antibiotics for pneumonia
E. Emergent complete blood count to evaluate for bleeding
答案解析：
英国胸科学会(BTS)因2005年至2008年间放置胸管造成的严重危害（12例死亡和15例严重危害），制定了一套胸管插入指南。指南建议在进行手术前进行标准化培训计划，在可能的情况下使用超声，首先放置小口径胸管，引流血胸除外。BTS指南还建议对气胸进行针吸引流，如果针吸引流失败，则仅放置胸管。大量证据不支持这些建议，但在该患者中，学员放置外科胸管存在疑问。x线片引起外科胸管进入纵隔的担忧。患者的发热和心动过速引起对纵隔炎的关注。适合进行CT以定位胸管，可能需要咨询胸外科医生。由于小孔径胸管堵塞，初始气胸未消退。小口径导管比大口径胸导管更常发生这种情况，但冲洗小口径胸导管往往可以缓解这一问题。
正确答案：A
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