Chest Radiograph After Thoracentesis: Is It Always Necessary?

Purpose: The goal of this study is to evaluate the rate of pneumothorax after imaged guided thoracentesis and how the necessity for further intervention can impact patient management and workflow.

Materials and Methods: 817 patients received thoracentesis in this single institution retrospective review. Inclusion criteria: age >18 years; image guided thoracentesis performed between January 1, 2014 and May 1, 2022. In our institution, the protocol for imaged guided thoracentesis includes a post procedure chest X-ray and physician review for complications, including pneumothorax. We defined post thoracentesis pneumothorax complications as minor if there was no need for treatment and major if the was need for treatment of the pneumothorax in accordance with SIR guidelines.

Results: 817 patients met the inclusion criteria (n= 402 [49%] female, age range 19-97, median 63; n= 415 [51%] male, age range 19-96, median 64). Overall, 2.9% (24) had a pneumothorax adverse event after imaged guided thoracentesis. 2.5 % (21) had a minor adverse event (stable pneumothorax) with no treatment needed and patients were discharge home the same day. None of these patients were symptomatic. Only 0.37% (3) of patients had a major adverse event requiring chest tube placement for the pneumothorax. Treatment for all 3 consisted of a chest tube and hospital admission. Chest tube was removed after resolution of pneumothorax in a mean of 3.6 days. Two patients were admitted, and length of stay was 3 and 6 days, with an uneventful hospital course.

Conclusion:

Pneumothorax after imaged guided thoracentesis is rare and treatment (chest tube placement) for a pneumothorax following thoracentesis is even more scarce. Most of the pneumothorax after thoracentesis are small, asymptomatic and require no treatment or intervention. Thus, we conclude that chest radiograph after thoracentesis may not always be necessary, especially for asymptomatic patients.

 

Clinical relevance: Pneumothorax after image guided thoracentesis is very rare and even when it happens is subclinical, not needing treatment. Chest radiograph after thoracentesis may be redundant, probably not necessary, and an additional cost in asymptomatic patients. Additionally, this can implicate a decrease in health care cost related to the chest radiographs.