Thoracentesis

Original Editor - Reem Ramadan Top Contributors - Reem Ramadan


Description[edit | edit source]

Thoracentesis is a minimally invasive procedure that involves removing excessive fluid or air from the lungs by injecting a hollow needle through the chest wall and into the pleural space after the administration of local anesthesia. This procedure can be done in either a sitting or supine position depending on the patient's comfort and his underlying condition[1].

The illustration shows a person having thoracentesis. The person sits upright and leans on a table. Excess fluid from the pleural space is drained into a bag.

Indications[edit | edit source]

Thoracentesis is done whenever there is excessive fluid in the space between the lungs and the chest wall. It is considered a diagnostic procedure when the presence of excessive fluid is of unknown etiology where the healthcare professional collects a small volume of the fluid, typically using a single 20cc to 30cc syringe, for laboratory and pathological analysis[2]. In addition to that, it is also considered a therapeutic procedure when the present excessive fluid is causing significant clinical symptoms and after the failure of initial medical management such as the use of diuresis and treatment of the underlying cause which can be congestive heart failure, cancer, pneumonia, autoimmune diseases such as lupus, tuberculosis or pulmonary hypertension[3].

Clinical Presentation[edit | edit source]

Following this procedure, most patients experience relief of symptoms such as dyspnea, pleuritic chest pain, a vague discomfort or sharp pain that worsens during inspiration where according to a study conducted on 284 patients who underwent thoracentesis, 71.8% of patients survived 30 days after this procedure where the majority of the patients demonstrated sustained improvement in dyspnea and the mental aspect of quality of living 30 days following thoracentesis, independent of the etiology and regardless of the volume of pleural fluid removed and the minority experienced sustained improvements in the physical aspect of quality of living and basic activities of daily living[4].

Diagnostic Tests[edit | edit source]

To identify whether a patient requires a thoracentesis a computed tomography (CT) scan, ultrasonography, or lateral decubitus x-ray is required and the procedure is indicated upon the discovery of pleural effusion that is ≥ 10 mm in thickness[5].

Post-Op[edit | edit source]

After thoracentesis, obtaining radiological imaging (usually chest x-ray or ultrasonography) is routine standard practice to rule out pneumothorax, but is often unnecessary when the patient is asymptomatic. In addition to that, analgesia with oral nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen is often administrated if needed. Furthermore, patients are advised to report any shortness of breath or chest pain and its important to note that coughing is usually common after fluid removal and is not a cause for concern[6].

References[edit | edit source]

  1. LeVasseur RA. Thoracentesis. In: Richardson JD, Bland KI, editors. The Mont Reid Surgical Handbook. 6th ed. Philadelphia, PA: Saunders/Elsevier; 2008. p. 835-838.
  2. Terra RM, Vega AJ. Treatment of malignant pleural effusion. Journal of Visualized Surgery. 2018;4.
  3. Leo F, Makowska M. Thoracentesis-Step by Step. Deutsche Medizinische Wochenschrift (1946). 2018 Aug 7;143(16):1186-92.
  4. Argento AC, Murphy TE, Pisani MA, Araujo KL, Puchalski J. Patient-centered outcomes following thoracentesis. Pleura. 2015 Sep 1;2:2373997515600404.
  5. Alzghoul B, Innabi A, Subramany S, Boye B, Chatterjee K, Koppurapu VS, Bartter T, Meena NK. Optimizing the Approach to Patients With Pleural Effusion and Radiologic Findings Suspect for Cancer. Journal of Bronchology & Interventional Pulmonology. 2019 Apr 1;26(2):114-8.
  6. Gervais DA, Petersein A, Lee MJ, Hahn PF, Saini S, Mueller PR. US-guided thoracentesis: requirement for postprocedure chest radiography in patients who receive mechanical ventilation versus patients who breathe spontaneously. Radiology. 1997 Aug;204(2):503-6.