Diaphragmatic Musculophrenic Vessel Injury Following Ultrasound-Guided Pigtail Catheter Insertion: A Rare Case

Pigtail catheters are widely used as a minimally invasive substitute to large-bore chest tubes for the management of pleural effusion. Although it is considered safe, serious complications may occur. We report a rare case of diaphragmatic musculophrenic artery injury following ultrasound-guided pigtail catheter insertion. A 39-year-old female with multiple comorbidities was admitted with an impression of pleural effusion. She underwent ultrasound-guided pigtail catheter insertion, with drainage of hemorrhagic exudative fluid. Within one hour, she developed severe dyspnea and chest pain. Imaging revealed a hydropneumothorax, necessitating urgent intercostal chest drain placement. Despite initial clinical improvement, she rapidly deteriorated, prompting emergency thoracotomy. Intraoperative findings revealed a bleeding musculophrenic artery at the diaphragmatic surface, likely injured during pigtail placement. Hemostasis was achieved, and the patient recovered uneventfully. This case reports a rare but life-threatening complication of pigtail catheter insertion. Awareness of anatomical proximity to diaphragmatic vessels and prompt recognition of complications are critical to avoid morbidity and mortality.