Optimum chest tube placement for an infant with a pneumothorax is in the

• A. Anterior chest
• B. Lateral chest
• C. Posterior chest
• D. Inferior chest

Answer: (A)

Air accumulates in the highest part of the pleural space, and in an infant who is typically lying on their back, that apex is toward the anterior chest wall. Draining from the anterior/apical region allows air to flow readily into the tube and the lung to re-expand quickly. The anterior approach gives the most direct access to the top of the pleural cavity in a tiny chest and minimizes risk to surrounding structures.

A lateral or posterior site is less effective for removing intrapleural air and can be harder to access in a small infant, while an inferior site risks injuring abdominal organs and does not efficiently drain the apical air.