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Communications to the Editor |

Factors Contributing to Pneumothorax After Thoracentesis FREE TO VIEW

G. Díaz, MD; David Jiménez Castro, MD; Esteban Pérez-Rodríguez, MD
Author and Funding Information

Affiliations: Madrid, Spain,  La Jolla, CA

Correspondence to David Jiménez Castro, MD, Servicio de Neumologia, Hospital Ramón y Cajal, Apartado 31057, Madrid E 28080, Spain



Chest. 2000;117(2):608-609. doi:10.1378/chest.117.2.608-a
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Published online

To the Editor:

We read with interest the report by Colt et al (July 1999)1 on the factors contributing to pneumothorax following thoracentesis. The authors found that pneumothoraces occurred in 5.4% of cases and chest tube drainage was required in 0.78% of cases. The authors concluded that pneumothorax following thoracentesis is a rare event and not easily predictable if performed by experienced operators.

We wish to report the results of our prospective study. We performed 620 consecutive thoracenteses in a 4-year period. Based on the radiographic criteria, 397 effusions (64.03%) were small (visually assessed to be < 15% on chest radiograph). We identified 15 pneumothoraces (2.26%), and chest tube drainage was required in three instances (0.48%).

Hospitalization status, critical illness, effusion size or type, underlying illness, operator, needle type, amount of fluid withdrawn, patient characteristics, occurrence of dry tap, and type of thoracentesis were analyzed. The only predictor variable demonstrating statistical significance was noncollaborator patient (six patients with a diagnosis of dementia, two patients < 10 years old, two patients with Down’s syndrome, and a patient with cerebral paralysis).

One limitation of this study is that we perform postprocedure chest radiographs only on a clinical suspicion basis, and this could explain the low incidence of pneumothoraces. On the other hand, it is our practice not to use ultrasound examination unless we don’t recover pleural fluid at the first attempt (dry tap).

In summary, thoracentesis is a very safe procedure with few complications. We strongly believe that a noncollaborator patient is the only absolute contraindication to perform this technique.

References

Colt, HG, Brewer, N, Barbur, E (1999) Evaluation of patient-related and procedure-related factors contributing to pneumothorax following thoracentesis.Chest116,134-138
 
To the Editor:

We thank Dr. Diaz and colleagues for their interest in our article (July 1999). Their findings further confirm that thoracentesis is a particularly safe procedure, although the lack of routine chest radiographs in their study may have caused them to miss asymptomatic pneumothoraces. From a clinical standpoint, we agree that postprocedure chest radiographs need only be performed in case of clinical suspicions of a complication.1Their selective use of pleural ultrasonography is logical. Of course, it also raises issues of logistics and institutional practice patterns. Most primary care and medical subspecialty physicians do not have ready access to an ultrasound machine, forcing them to refer patients to the interventional radiologist. Although ultrasound examinations need not be performed for most thoracenteses, I remain a firm believer in the eventual democratization of pleural ultrasonography.2 Widespread use of ultrasound has already occurred in several medical and surgical specialities, and is likely to occur eventually, in pulmonary medicine as well. In addition, the incorporation of pleural ultrasonography into pulmonary training and practice, I believe, will eventually result in a better understanding of pleural-pulmonary relationships, increased levels of confidence for our trainees, and, as demonstrated by several investigators, fewer procedure-related complications.

References
Doyle, JJ, Hnatiuk, OW, Torrington, KG, et al Necessity of routine chest roentgenography after thoracentesis.Ann Intern Med1996;124,816-820
 
Colt, HG, Mathur, PN Ultrasonography of the pleura.Manual of pleural procedures1999,37-44 Lippincott Williams and Wilkins. Philadelphia, PA:
 

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References

Colt, HG, Brewer, N, Barbur, E (1999) Evaluation of patient-related and procedure-related factors contributing to pneumothorax following thoracentesis.Chest116,134-138
 
Doyle, JJ, Hnatiuk, OW, Torrington, KG, et al Necessity of routine chest roentgenography after thoracentesis.Ann Intern Med1996;124,816-820
 
Colt, HG, Mathur, PN Ultrasonography of the pleura.Manual of pleural procedures1999,37-44 Lippincott Williams and Wilkins. Philadelphia, PA:
 
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