We read with interest the point-counterpoint editorial debate on routine use of pleural manometry during thoracentesis in CHEST (April 2012).1,2 Maldonado and Mullon,2 in their counterpoint argument, write that pleural manometry adds valuable information and they use it, but not on a routine basis. We are interested in knowing how they decide when to and when not to use this technique. They suggest that a better way to show that the lung has expanded is by “maximal fluid removal,” followed by ultrasound imaging. Maximal fluid removal may not necessarily mean complete emptying of the pleural space, as the procedure at times is stopped when an arbitrary cut-off volume is reached or when the patient develops symptoms, such as intractable cough, severe pain, and chest discomfort. In their study, Feller-Kopman et al3 recommend that attention should be paid to symptoms during thoracentesis, as the development of chest discomfort is associated with a potentially unsafe drop in pleural pressure. We have pleural manometry data on 140 patients and have not seen the same correlation. We agree with the suggestion made by Feller-Kopman et al3 that one should pay attention to both symptoms and pleural pressures in guiding thoracentesis, but differ by saying that both chest discomfort and chest pain may be of concern, alone or as a combination.