Post-ICD (Intercostal Drain) Chest X-Ray Report

Findings

• A right-sided intercostal drain is in situ.
• Entry point is at the right lateral chest wall, approximately the 5th-6th intercostal space.
• The tip courses medially and superiorly, terminating in the mid-to-lower right hemithorax.
• ⚠️ Despite the ICD being in place, the right hemithorax remains completely opacified - suggesting either inadequate drainage, tube blockage, or massive ongoing fluid/blood accumulation.

• Near-complete opacification ("white-out") of the entire right hemithorax.
• This is consistent with a massive pleural effusion or hemothorax - likely the indication for drain placement.
• The right heart border is completely obscured (silhouette sign positive).

• Clear left lung field with normal pulmonary vascular markings.
• No pneumothorax, consolidation, or effusion on the left.

• Significant leftward mediastinal shift and tracheal deviation to the left.
• This indicates a large mass effect from the right-sided pathology - consistent with tension physiology or massive fluid volume.

• Extensive subcutaneous emphysema along the right lateral chest wall, axilla, and right supraclavicular region - may be related to the drain insertion or underlying injury.
• The right hemithorax opacification persists post-drain insertion, raising concern for:
  • Drain malposition (tip not within the fluid collection)
  • Tube kinking or blockage
  • Massive hemothorax exceeding drain capacity
  • Possible loculated effusion

Impression

1. Massive right-sided pleural effusion / hemothorax with near-complete right lung white-out.
2. Significant leftward mediastinal shift - mass effect physiology.
3. Right-sided intercostal drain in place, but right hemithorax remains opacified - drain efficacy should be clinically assessed urgently.
4. Subcutaneous emphysema right lateral chest wall and axilla.
5. Left lung clear.

Suggested Next Steps

• Check ICD patency - milking the tube, confirm it is not kinked or clamped.
• Assess drain output - if minimal despite white-out, consider drain repositioning or insertion of an additional drain.
• Urgent clinical review for hemodynamic stability (given mass effect and possible tension physiology).
• Consider CT chest if drain output remains poor to assess fluid loculation or drain position.