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Background: A significant number of patients are treated by doctors in the emergency room due to the rising incidence of catastrophic chest injuries. For the treatment of pneumothorax, hemothorax, and hemopneumothorax resulting from chest trauma, a tube thoracostomy is a vital life-saving procedure. Objective: To outline potential issues with Thoracostomy tube insertion and typical pitfalls in managing the underwater seal system. Methodology: This retrospective study was carried out at General / Thoracic Surgery Department of Hayatabad Medical Complex Peshawar between July 2020 and December 2021. Total 300 patients were included in this study. Complications related to the thoracostomy tube insertion and mistakes practiced by the medical staff regarding the management of thoracostomy tube and its system were documented and analyzed. Results: There were 22 (7.3%) complications were related to tube insertion, 13 (4.3%) iatrogenic lung injuries occurred during the insertion process, followed by diaphragmatic injury 4 (1.3%), intercostal vessel injury 3 (1%) & liver injury 2 (0.7%) respectively. There were total 118 (39.3%) pitfalls were observed, amongst which the most common was clamping the chest tube 29 (9.7%), followed by intrathoracic malposition 22 (7.3%), loose fixation 18 (6%), improper handling of suction system 15 (5%), vent covering 12 (4%), improper filling of the bottle 9 (3%), subcutaneous position 7 (2.3%), improper insertion site 6 (2%) respectively. Conclusion: The trocar was the cause of all chest tube insertion-related issues. It is common to make mistakes when working with the tube and its system. All surgeons, especially general surgery residents and paramedical staff should complete specialised training in chest tube management and care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the anatomic location of cysts, operative characteristics of intrathoracic extrapulmonary hydatid cyst and to determine the outcome of aggressive surgical interventions. Study Design: Case series. Place and Duration of Study: Thoracic Surgery Unit Lady Reading Hospital Peshawar from 1st July 2008 to 30th June 2011. Methodology: All patients admitted to Thoracic unit from July 2008 to June 2011 with intra thoracic hydatid cysts were evaluated prospectively as to age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes. Chest radiography, computed tomography, and thoracic and abdominal ultrasonography had been performed preoperatively in all of them. Bronchoscopy and spirometry was also performed in all patients for assessment and operability. Echocardiography had been used in 2 patients to determine the contiguity of the cyst to the pericardium. Cystectomy and wide resection were the chief operative procedures. Most of the patients were having cysts in the pulmonary parenchyma only 10 patients had intrathoracic cysts in extrapulmonary locations. This group of patients was included in the study. We excluded patients who had a parenchymal cyst that had perforated to the pleura, myocardial hydatid and patients who had experienced transdiaphragmatic transmission. Results: Total of 149 patients were operated for hydatid cystectomy, out of these 139 patients had pulmonary hydatid and 10 patients had intrathoracic extrapulmonary hydatid cysts. These 10 patients constitute our study group; out of these 7 were men and 3 women whose mean age was 39.14 ± 16.8 years (range, 16-69 years). Eight (80%) of these were symptomatic, most commonly with chest pain, two patients were asymptomatic. There were 2 (20%) mediastinal hydatid, 2 (20%) diaphragmatic, 2 (20%) pericardial, 2 (20%) oblique fissure, and 1 (10%) each in chest wall and pleural hydatid in our study. Albendazole (10 mg/kg) was prescribed to all patients for as long as 3 months postoperatively. No complication, recurrence, or death occurred during the follow up period of 13 ± 15.4 months (range, 2-36 months). Conclusion: The extrapulmonary location of Hydatid cysts within the thorax is very rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely and an anthelmintic medical regimen post operatively. [ABSTRACT FROM AUTHOR]