Limited utility of chest radiograph after thoracentesis

Chest. 2000 Apr;117(4):1038-42. doi: 10.1378/chest.117.4.1038.


Study objective: To assess the utility of chest radiograph (CXR) immediately after routine thoracentesis.

Design: Prospective cohort study.

Setting: Multispecialty clinic/teaching hospital.

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

Measurements: 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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Female
  • Humans
  • Inpatients
  • Male
  • Outpatients
  • Paracentesis*
  • Pleural Effusion / diagnostic imaging*
  • Pleural Effusion / surgery
  • Pneumothorax / diagnostic imaging*
  • Pneumothorax / etiology
  • Postoperative Care
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Radiography, Thoracic / statistics & numerical data*
  • Surveys and Questionnaires
  • Treatment Outcome