The value of chest roentgenography in the diagnosis of pneumothorax after thoracentesis.
OBJECTIVE
We sought to assess the yield of chest roentgenography for the detection of pneumothorax among hospitalized patients with pleural effusion who have undergone diagnostic or therapeutic thoracentesis.


METHODS
We performed a prospective study of 506 thoracentesis procedures in 370 patients. After the procedure, each operator filled out a note recording patient data and the characteristics of the thoracentesis. A chest radiograph was performed within 12 hours after the procedure in all patients.


RESULTS
Eighteen (4%) pneumothoraces occurred in 17 patients, 9 (2%) of which required chest tube drainage. Of the 488 patients without symptoms, only 5 (1%) developed a pneumothorax, only 1 of which required chest tube drainage. By contrast, of the 18 patients with symptoms, 13 developed a pneumothorax, 8 of which required chest tubes. There were two independent predictors of pneumothorax: presence of symptoms (odds ratio [OR] = 250; 95% confidence interval [CI]: 65 to 980) and male gender (OR = 5.4; 95% CI: 1.9 to 69).


CONCLUSIONS
Among the symptom-free patients in our sample, the risk of developing pneumothorax with clinical consequences was so low that the practice of routine chest roentgenography may not be justified.
Alemán
C
C
Service of Internal Medicine, Hospital General Vall d'Hebron, Universitat Autónoma, Barcelona, Spain.
Alegre
J
J
Armadans
L
L
Andreu
J
J
Falcó
V
V
Recio
J
J
Cervera
C
C
Ruiz
E
E
Fernández de Sevilla
T
T
D015505:Chest Tubes; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019152:Paracentesis / Q000009:adverse effects*; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011859:Radiography; D012306:Risk; D012307:Risk Factors; D013906:Thoracoscopy / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects*