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Clinical Investigations: PLEURA |

Limited Utility of Chest Radiograph After Thoracentesis*

William G. Petersen, MD; Robert Zimmerman, MD
Author and Funding Information

*From the Department of Pulmonary Medicine and Critical Care, Scott & White Clinic and Memorial Hospital, Scott, Sherwood and Brindley Foundation, Texas A&M University System Health Science Center, College of Medicine, Temple, TX.

Correspondence and reprint requests to: William G. Petersen, MD, Scott & White Clinic, 2401 S. 31st St, Temple, TX 76508



Chest. 2000;117(4):1038-1042. doi:10.1378/chest.117.4.1038
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Published online

Study objective: To assess the utility of chest radiograph (CXR) immediately after routine thoracentesis.

Design: Prospective cohort study.

Setting: Multispecialty clinic/teaching hospital.

Participants: All outpatients and inpatients undergoing thoracentesis in the procedure area from October 1995 to January 1998.

Measurements: Immediately after thoracentesis, the physician completed a questionnaire assessing the likelihood of a complication. CXRs were obtained at physician discretion. Patient demographics, indications for thoracentesis, use of ultrasound guidance, level of training, radiographic interpretation, and eventual patient outcome were recorded.

Results: Two hundred eighteen patients were enrolled for a total of 278 thoracenteses. Two hundred fifty-one procedures performed on 199 patients could be prospectively evaluated. A complication was suspected in 30 procedures; immediate CXR confirmed such in 9 (30%). There were 221 procedures with no clinical suspicion or indication of a complication. Ninety CXRs were obtained immediately after the procedure; the remaining 131 procedures had no CXR. The complication rates were 3.3% and 2.3%, respectively, for these groups. Four postthoracentesis radiographs demonstrated additional findings regardless of the indication for the radiograph.

Conclusions: In the absence of a clinical indication of a complication, chest radiography is not indicated immediately after routine thoracentesis. Aspiration of air strongly correlates with the occurrence of pneumothorax, whereas pain, hypotension, and dry tap do not. Use of a vacuum bottle to withdraw fluid obscures the appreciation of this finding and was identified as a risk factor for subsequent pneumothorax. Additional radiographic findings are rarely detected and may not contribute to clinical management.


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