Elsevier

Academic Radiology

Volume 12, Issue 8, August 2005, Pages 980-986
Academic Radiology

Original investigation
Management of Patients with “Ex Vacuo” Pneumothorax After Thoracentesis1

https://doi.org/10.1016/j.acra.2005.04.013Get rights and content

Rationale and Objectives

To determine clinical outcome in patients who developed “ex vacuo” pneumothorax following thoracentesis and to assess the benefit of chest tube placement for this complication.

Materials and Methods

We retrospectively reviewed records of 282 patients who underwent 437 thoracenteses at a single institution during a 6-year period. We identified 34 patients (12.1%) who developed a pneumothorax following 39 thoracenteses (8.8%) and then identified a subset of patients with pneumothorax “ex vacuo” defined as a moderate to large hydropneumothorax or small pneumothorax persisting for more than 3 days. Patient charts were reviewed to document the treatment strategy employed and subsequent clinical outcome, which included length of hospital stay, resolution of pneumothorax, reaccumulation of pleural effusion, and overall survival.

Results

Ten patients developed “ex vacuo” pneumothroax following thoracentesis. None complained of significant worsening of symptoms following thoracentesis. Seven patients were treated by observation alone and 3 patients underwent tube thorocostomy. A decrease in size of the pneumothorax was observed in only 3 patients, none of whom had a chest tube placed. Effusion completely reaccumulated in 7 patients. All 10 patients died during the follow-up period; the mean survival was 157 days (range: 13–402 days). Survival among patients treated by observation was 191.4 days versus 71.7 days for patients receiving chest tubes.

Conclusion

Life expectancy for most patients who develop “ex vacuo” pneumothorax following therapeutic thoracentesis is short (<6 months). Chest tube placement is not necessary in asymptomatic patients and is unlikely to provide clinical benefit.

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

References (11)

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