Rare Complication of Chest Tube Placement: Recurrent Laryngeal Nerve Palsy

The placement of chest tubes in Bülau position is an established method for treating pneumothorax resulting from thoracic trauma. While complications involving nerve structures are rare, they can be clinically relevant. This case report describes a complication not previously mentioned in the literature: recurrent laryngeal nerve palsy caused by the position of the tube tip near the recurrent laryngeal nerve at the upper lung apex.A 47-year-old patient with right-sided traumatic pneumothorax and rib fractures developed progressive hoarseness following initial chest tube placement. Clinical examination revealed recurrent laryngeal nerve palsy. CT imaging showed the tube tip located at the junction of the lung apex and mediastinum in close proximity to the recurrent laryngeal nerve, which was considered the likely cause.After partial retraction of the chest tube, administration of systemic prednisolone, and initiation of speech therapy, the patient showed rapid clinical improvement. Following the full resolution of the pneumothorax, the patient was discharged. At follow-up, the recurrent laryngeal nerve palsy had completely resolved.This case emphasizes the importance of precise chest tube positioning, particularly in the region of the lung apex and mediastinum, to prevent rare neurological complications such as recurrent laryngeal nerve palsy. In the event of new neurological symptoms, immediate radiological assessment is essential to identify potential complications and initiate appropriate measures.