Chest
Volume 123, Issue 2, February 2003, Pages 418-423
Journal home page for Chest

Clinical Investigations
PLEURA
Ultrasound-Guided Thoracentesis*: Is It a Safer Method?

https://doi.org/10.1378/chest.123.2.418Get rights and content

Study objectives:

The objectives of this study are as follows: (1) to determine the incidence of complications from thoracentesis performed under ultrasound guidance by interventional radiologists in a tertiary referral teaching hospital; (2) to evaluate the incidence of vasovagal events without the use of atropine prior to thoracentesis; and (3) to evaluate patient or radiographic factors that may contribute to, or be predictive of, the development of re-expansion pulmonary edema after ultrasound-guided thoracentesis.

Design:

Prospective descriptive study.

Setting:

Saint Thomas Hospital, a tertiary referral teaching hospital in Nashville, TN.

Patients:

All patients referred to interventional radiology for diagnostic and/or therapeutic ultrasound-guided thoracentesis between August 1997 and September 2000.

Results:

A total of 941 thoracenteses in 605 patients were performed during the study period. The following complications were recorded: pain (n = 25; 2.7%), pneumothorax (n = 24; 2.5%), shortness of breath (n = 9; 1.0%), cough (n = 8; 0.8%), vasovagal reaction (n = 6; 0.6%), bleeding (n = 2; 0.2%), hematoma (n = 2; 0.2%), and re-expansion pulmonary edema (n = 2; 0.2%). Eight patients with pneumothorax received tube thoracostomies (0.8%). When > 1,100 mL of fluid were removed, the incidence of pneumothorax requiring tube thoracostomy and pain was increased (p < 0.05). Fifty-seven percent of patients with shortness of breath during the procedure were noted to have pneumothorax on postprocedure radiographs, while 16% of patients with pain were noted to have pneumothorax on postprocedure radiographs. Vasovagal reactions occurred in 0.6% despite no administration of prophylactic atropine. Re-expansion pulmonary edema complicated 2 of 373 thoracenteses (0.5%) in which > 1,000 mL of pleural fluid were removed.

Conclusions:

The complication rate with thoracentesis performed by interventional radiologists under ultrasound guidance is lower than that reported for non–image-guided thoracentesis. Premedication with atropine is unnecessary given the low incidence of vasovagal reactions. Re-expansion pulmonary edema is uncommon even when > 1,000 mL of pleural fluid are removed, as long as the procedure is stopped when symptoms develop.

Section snippets

Materials and Methods

After approval by the institutional review board, all patients referred to interventional radiology for a diagnostic and/or therapeutic ultrasound-guided thoracentesis between August 1997 and September 2000 were enrolled in this study and evaluated prospectively. The decision to perform ultrasound-guided thoracentesis was made by the patient’s referring physician. Symptoms as reported by the patient or complications as noted by the interventional radiologist performing the procedure were

Results

Between August 1997 and September 2000, 605 patients were enrolled in the study and underwent a total of 941 procedures. These included 668 initial procedures and 273 repeat procedures. Because of multiple procedures, it was possible for patients to appear in both groups; because of bilateral thoracenteses, there were more initial procedures than patients. The volume of fluid removed from the patients ranged from 1 to 3,800 mL (median, 800 mL). In three patients, < 10 mL fluid was removed; in

Discussion

The purpose of this study was to determine the incidence of complications with ultrasound-guided thoracentesis performed by interventional radiologists in a large patient population; to determine the necessity for prophylactic atropine; and to determine potential patient or radiographic factors that may contribute to, or be predictive of, the development of re-expansion pulmonary edema. This study demonstrates that ultrasound-guided thoracentesis, when performed by interventional radiologists,

Conclusion

In conclusion, this study demonstrates that ultrasound-guided thoracentesis by interventional radiologists is associated with a lower incidence of complications than those reported for thoracentesis without direct imaging guidance. Postthoracentesis chest radiographs should only be obtained if a pneumothorax is suspected clinically, when air is aspirated during the procedure, or when tactile fremitus is lost over the superior portion of the aspirated hemithorax. The development of pain or

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    Supported in part by The Saint Thomas Foundation, Nashville, TN.

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