Routine chest X-rays after pigtail chest tube removal rarely change management in children

Christina M. Theodorou, Mennatalla S. Hegazi, Hope Nicole Moore, Alana L. Beres

Research output: Contribution to journalArticlepeer-review


Background: The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management. Methods: Patients < 18 years old with pigtail chest tubes placed 2014–2019 at a tertiary children’s hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion. Results: 111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax. Conclusions: Post-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.

Original languageEnglish (US)
Pages (from-to)1447-1451
Number of pages5
JournalPediatric Surgery International
Issue number10
StatePublished - Oct 2021


  • Chest tube
  • Pediatric surgery
  • Pigtail thoracostomy
  • X-ray

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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