Ultrasound-guided thoracentesis: is it a safer method?
OBJECTIVE
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.


METHODS
Prospective descriptive study.


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


METHODS
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.
Jones
Phillip W
PW
Saint Thomas Hospital, and Vanderbilt University, Nashville, TN 37205, USA.
Moyers
J Phillip
JP
Rogers
Jeffrey T
JT
Rodriguez
R Michael
RM
Lee
Y C Gary
YC
Light
Richard W
RW
D015505:Chest Tubes; D003371:Cough / Q000209:etiology; D006784:Hospitals, Teaching; D006801:Humans; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology; D012306:Risk; D012449:Safety; D019462:Syncope, Vasovagal / Q000209:etiology*; D013714:Tennessee; D013907:Thoracostomy / Q000009:adverse effects; D018084:Ultrasonography, Interventional / Q000009:adverse effects