Which factor could cause a chest tube to fail to re-expand the lung after insertion?

• A. Rapid lung expansion
• B. Noncompliant lung due to underlying disease; persistent air leak; blockage; incorrect insertion; ongoing pleural disease
• C. Adequate healing without leak
• D. Blood in the drainage is the only concern

Answer: (B)

Re-expansion after chest tube placement hinges on removing the factors that keep the lung from expanding. If the lung itself is noncompliant from underlying disease, its tissue is stiff or damaged and won’t recoil outward even once the pleural space is drained. A persistent air leak means air continues to enter the pleural space, so drainage can’t fully clear the space to allow expansion. A blocked chest tube or drainage system prevents removal of air or fluid, keeping the space occupied and preventing full re-expansion. Incorrect insertion can place the tube in the wrong location or fail to access the pleural space effectively, so no adequate drainage occurs. Ongoing pleural disease, such as thickened pleura or malignant involvement, mechanically hinders expansion. By contrast, rapid lung expansion isn’t a cause of failure to re-expand (it can even risk re-expansion edema), and healing without leak supports re-expansion rather than impeding it. Blood in the drainage is a concern to monitor, but not the primary reason for failure to re-expand.