Iatrogenic trauma to the thorax.

With more sophisticated medical procedures and treatment for the critically ill patient, iatrogenic damage to the thorax has become increasingly common. But simple radiologic procedures, such as chest radiography and fluoroscopy, permit diagnosis of unsuspected and clinically silent complications. A very important iatrogenic trauma to the lung depends on the increasing use of overpressure ventilation. Experimental evidence shows that the lung can be damaged with interstitial emphysema at peak pressures as low as 40 cm H2O. The chest radiograph may show and early pathognomonic finding of perivascular air collections. The respirator treatment should then be modified to avoid pneumomediastinum and pneumothorax. The placement of catheters, chest tubes, endotracheal tubes, and feeding tubes as well as pacemaker electrodes and counterpulsation balloons may cause serious complications. Follow-up chest radiography after these procedures is therefore important.