The value of chest roentgenography in the diagnosis of pneumothorax after thoracentesis

• Published in: The American journal of medicine Vol. 107; no. 4; p. 340
• Main Authors: Alemán, C, Alegre, J, Armadans, L, Andreu, J, Falcó, V, Recio, J, Cervera, C, Ruiz, E, Fernández de Sevilla, T
• Format: Journal Article
• Language: English
• Published: United States 01-10-1999
• Subjects: Chest Tubes; Decision Trees; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Odds Ratio; Paracentesis - adverse effects; Pleural Effusion - diagnosis; Pleural Effusion - etiology; Pleural Effusion - therapy; Pneumothorax - diagnostic imaging; Pneumothorax - etiology; Pneumothorax - therapy; Radiography; Risk; Risk Factors; Thoracoscopy - adverse effects; Thoracotomy - adverse effects
• ISSN: 0002-9343
• DOI: 10.1016/S0002-9343(99)00238-7

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.
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.
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).
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.