Original investigationManagement of Patients with “Ex Vacuo” Pneumothorax After Thoracentesis1
Section snippets
Materials and methods
We reviewed the electronic medical records of all patients who underwent ultrasound-guided thoracentesis by interventional radiology between June 1997 and June 2003. This retrospective study was approved by the hospital’s institutional review board.
Thoracentesis was performed using sonographic localization by an attending interventional radiologist. In most cases an initial ultrasound evaluation was performed to identify the pleural effusion and select an appropriate puncture site. Then, after
Results
The study population includes three men and seven women who were 34–84 years of age (mean 64 years). All 10 patients had underlying malignant disease documented by cytologic evaluation of the pleural fluid. The primary malignancies were breast cancer (n = 4), lung cancer (n = 2), ovarian cancer (n = 1), osteogenic sarcoma (n = 1), pancreatic cancer (n = 1), and cancer of unknown origin (n = 1). The indication for thoracentesis in all cases was symptomatic shortness of breath.
The volume of fluid
Discussion
Ex vacuo pneumothorax is an uncommon complication of thoracentesis, but one that presents a difficult management dilemma for the interventionalist. Chest tube insertion is the standard treatment for large or symptomatic pneumothorax, but whether or not it is necessary or beneficial in the subset of patients with ex vacuo pneumothorax is not known. That is, when pneumothorax is due to a technical complication of the procedure (such as a lapse in technique that allows air to enter the pleural
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2010, ThoraxCitation Excerpt :Ponrartana et al confirmed the finding that chest drain insertion as a treatment of an ex vacuo pneumothorax is unlikely to be helpful in decreasing the size of the pneumothorax. They also found that the presence of an ex vacuo pneumothorax in the context of malignant disease is associated with a poor13 prognosis. We conclude that, if an ex vacuo pneumothorax occurs after drainage of a pleural effusion due to non-expansile or trapped lung, the pneumothorax should not routinely be drained.
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