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Communications to the Editor |

Chest Radiography Following Thoracentesis Chest Radiography Following Thoracentesis FREE TO VIEW

Oleh W. Hnatiuk, Lt Col, MD, FCCP
Author and Funding Information

Affiliations: Walter Reed Army Medical Center Washington, DC,  Scott and White Memorial Clinic/Hospital Temple, TX

Correspondence to: Lt Col Oleh W. Hnatiuk, MD, FCCP, Chief, Pulmonary and Critical Care Medicine, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001; e-mail: oleh.hnatiuk@na.amedd.army.mil.



Chest. 2000;119(4):1289. doi:10.1378/chest.119.4.1289
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To the Editor:

There is a growing body of literature suggesting that asymptomatic patients do not require chest radiography after routine, uncomplicated thoracentesis. Two recent studies have added significantly to this premise. In the study by Petersen and Zimmerman (April 2000)1the authors conducted a prospective cohort study of 207 outpatients and inpatients undergoing 278 thoracenteses from October 1995 to January 1998. In their conclusions the authors stated that “… in the absence of a clinical indication of a complication, chest radiography is not indicated immediately after routine thoracentesis.” They found that the aspiration of air during the procedure correlated strongly with pneumothorax. This study followed on the heels of a study by Aleman and colleagues2 evaluating 506 thoracenteses in 370 hospitalized patients in which the authors also concluded that: “Among the symptom-free patients in our sample… the practice of routine chest roentgenography may not be justified.” In the study by Aleman et al,2 only the presence of symptoms and male gender were independent predictors of pneumothorax. The aspiration of air during the procedure was related to pneumothorax only in unadjusted analysis.

This conclusion is in contrast to the first study mentioned, as well as our 1996 prospective cohort study3 (not retrospective, as Petersen and Zimmerman state) evaluating 110 hospitalized patients undergoing 174 thoracenteses. Although risk factors that predict pneumothorax vary from study to study, the one thing that we all agree on is that, for patients undergoing thoracentesis without operator-suspected pneumothorax, immediate chest radiography is unnecessary. It is encouraging to see that the risk for significant morbidity and mortality after this procedure remains low and that the clinical status of the patient is being included in the decision-making process of ordering postthoracentesis chest radiographs. I agree with Petersen and Zimmerman that the official guidelines need amendment, and I agree with Aleman and colleagues that such a change would result in a considerable savings of hospital resources.

Petersen, WG, Zimmerman, R (2000) Limited utility of chest radiography after thoracentesis.Chest117,1038-1042. [CrossRef] [PubMed]
 
Aleman, C, Alegre, J, Armadans, L, et al The value of chest roentgenography in the diagnosis of pneumothorax after thoracentesis.Am J Med1999;107,340-343. [CrossRef] [PubMed]
 
Doyle, JJ, Hnatiuk, OW, Torrington, KG, et al Necessity of routine chest roentgenography after thoracentesis.Ann Intern Med1996;124,816-820. [PubMed]
 

Chest Radiography Following Thoracentesis

To the Editor:

It was gratifying to review the comments by Dr. Hnatiuk. I did not intend to infer that their study1 was retrospective in design. On the contrary, it was clearly designed and completed as a prospective study. Our wording was regrettably poor.

However, in that study, all patients did undergo chest radiography regardless, thus, there was no prospective attempt to forego the chest radiograph. Our study did advance their findings by the inclusion of outpatients. More importantly, we were able to demonstrate that the decision to omit the chest radiograph could be made easily and without detriment to the patient. I await the next publication and, hopefully, revision of the American Thoracic Society guidelines for thoracentesis.

References
Doyle, JJ, Hnatiuk, OW, Torrington, KG, et al Necessity of routine chest roentgenography after thoracentesis.Ann Intern Med1996;124,816-820. [PubMed]
 

Figures

Tables

References

Petersen, WG, Zimmerman, R (2000) Limited utility of chest radiography after thoracentesis.Chest117,1038-1042. [CrossRef] [PubMed]
 
Aleman, C, Alegre, J, Armadans, L, et al The value of chest roentgenography in the diagnosis of pneumothorax after thoracentesis.Am J Med1999;107,340-343. [CrossRef] [PubMed]
 
Doyle, JJ, Hnatiuk, OW, Torrington, KG, et al Necessity of routine chest roentgenography after thoracentesis.Ann Intern Med1996;124,816-820. [PubMed]
 
Doyle, JJ, Hnatiuk, OW, Torrington, KG, et al Necessity of routine chest roentgenography after thoracentesis.Ann Intern Med1996;124,816-820. [PubMed]
 
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