A chest X-ray is often performed routinely after thoracentesis, but many of these are negative. By identifying factors associated with pneumothorax, the ordering of radiographs after thoracentesis can be more cost effective.


Factors associated with increased risk of pneumothorax:

(1) more than 1 pass of the needle (multiple needle sticks)

(2) aspiration of air

(3) clinical suspicion of pneumothorax

(4) patient history of thoracic radiation


Factors not associated with an increased risk of pneumothorax

(1) gauge of needle

(2) volume of aspirate

(3) level of physician training


Evaluation of patients with one of the factors associated with pneumothorax:

(1) study group: 110 patients undergoing 174 thoracentesis procedures

(2) 110 films would not have been performed (63% reduction), of which 109 were negative, and 1 showed a minor pneumothorax

(3) 8 of 9 pneumothoraces after thoracentesis were detected in post-procedural radiographs performed on the remaining patients

(4) hemothorax was not detected on the post-procedure radiographs


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