Challenges in pulmonary embolismrelated pleural effusion: Tube troubles with methemoglobinemia

Pulmonary embolism (PE), often arising from deep vein thrombosis, can  present with pleural effusion. Inserting a chest tube for massive effusions carries inherent risks, including chest tube malposition and methemoglobinemia. We report a case of a 32-year-old female with moderate-to-high risk PE and massive pleural effusion. Complications included chest tube malposition, secondary pneumothorax, and methemoglobinemia. Initial chest tube placement drained pleural fluid but resulted in pneumothorax and methemoglobinemia due to prilocaine use. Careful management and monitoring were crucial. Pleural effusion can complicate PE, warranting interventions, but complications like chest tube malposition and methemoglobinemia should be anticipated and managed promptly.