Limited utility of chest radiograph after thoracentesis.
OBJECTIVE
To assess the utility of chest radiograph (CXR) immediately after routine thoracentesis.


METHODS
Prospective cohort study.


METHODS
Multispecialty clinic/teaching hospital.


METHODS
All outpatients and inpatients undergoing thoracentesis in the procedure area from October 1995 to January 1998.


METHODS
Immediately after thoracentesis, the physician completed a questionnaire assessing the likelihood of a complication. CXRs were obtained at physician discretion. Patient demographics, indications for thoracentesis, use of ultrasound guidance, level of training, radiographic interpretation, and eventual patient outcome were recorded.


RESULTS
Two hundred eighteen patients were enrolled for a total of 278 thoracenteses. Two hundred fifty-one procedures performed on 199 patients could be prospectively evaluated. A complication was suspected in 30 procedures; immediate CXR confirmed such in 9 (30%). There were 221 procedures with no clinical suspicion or indication of a complication. Ninety CXRs were obtained immediately after the procedure; the remaining 131 procedures had no CXR. The complication rates were 3.3% and 2.3%, respectively, for these groups. Four postthoracentesis radiographs demonstrated additional findings regardless of the indication for the radiograph.


CONCLUSIONS
In the absence of a clinical indication of a complication, chest radiography is not indicated immediately after routine thoracentesis. Aspiration of air strongly correlates with the occurrence of pneumothorax, whereas pain, hypotension, and dry tap do not. Use of a vacuum bottle to withdraw fluid obscures the appreciation of this finding and was identified as a risk factor for subsequent pneumothorax. Additional radiographic findings are rarely detected and may not contribute to clinical management.
Petersen
W G
WG
Department of Pulmonary Medicine and Critical Care, Scott & White Clinic, Temple, TX 76508, USA.
Zimmerman
R
R
D000368:Aged; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D010045:Outpatients; D019152:Paracentesis; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000601:surgery; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome