https://doi.org/10.4081/ecj.2026.14937
Massive subcutaneous emphysema and the “sentinel hole” phenomenon after chest drain placement in neoplastic trapped lung: a case report from the emergency department
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Published: 14 July 2026
Malignant pleural effusion may be complicated by non-expandable lung, a condition that increases the risk of iatrogenic complications during pleural drainage. A 91-year-old man developed massive subcutaneous emphysema after large-bore chest tube placement for malignant pleural effusion with non-expandable lung. Partial migration of the chest tube exposed proximal fenestrations to the subcutaneous tissue, creating a conduit for air propagation. Despite tube removal, emphysema progressed due to a persistent pleuro-cutaneous breach. Emergency decompression with multiple angio-catheters resulted in rapid clinical improvement. In non-expandable lung, the lack of pleural apposition prevents the drainage tract from sealing spontaneously, favouring persistent air leakage. Migration of chest tube fenestrations into soft tissues creates a low-resistance pathway for subcutaneous emphysema. Early recognition of lung non-expandability and cautious drainage strategies are essential to prevent severe iatrogenic complications.
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CRediT authorship contribution
Alessandro Rapino, and Matteo Bolognesi designed the project and wrote the paper. Alessandro Rapino, Matteo Bolognesi, Michela Cascio, Giuseppe Romano, and Raffaella Francesconi searched the literature for retrievable papers. Roberto De Giorgio and Matteo Guarino critically reviewed the paper. All authors have read and agreed to the published version of the manuscript.
Data Availability Statement
All data underlying the findings are fully available in the present paper.
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