Hemopneumothorax drainage (pleural effusion) is typically placed where?

• A. Posterior chest wall near the scapula
• B. More laterally in the lower part of the chest
• C. Medial mid-chest near sternum
• D. Superior chest above clavicle

Answer: (B)

For drainage of a hemopneumothorax, the goal is to reach the dependent pleural space so air and fluid can be removed efficiently. Fluid and blood tend to collect in the lower, lateral part of the pleural cavity when a patient is upright, so placing the chest tube laterally in the lower chest allows gravity to help drain the space effectively. This position typically corresponds to the midaxillary region in the lower intercostal spaces, with the tube inserted just above the rib to protect the intercostal vessels.

Other locations are less ideal for drainage of fluid. A posterior approach near the scapula can be blocked by the shoulder blade and may not access the space well; a medial mid-chest near the sternum is closer to the heart and mediastinal structures and is not optimal for pleural drainage; a site above the clavicle is used more for evacuating air from apical pneumothorax rather than evacuating fluid. Thus, a lateral, lower chest placement best targets the pleural space for effective drainage.