| A thoracentesis is a procedure during which a needle is inserted through the chest wall into the pleural space (the space between the membranes lining the chest wall and those surrounding the lungs) to remove accumulated pleural fluid. Thoracentesis is performed to diagnose a condition, provide therapeutic benefit, or both. |
Source: Medical Disability Advisor
| Diagnostic thoracentesis is performed to determine the cause of abnormal fluid accumulation (pleural effusion) between the membranes lining the lungs and those lining the chest cavity. The various causes of accumulated fluids in the pleural cavity (pleural effusion) can be identified via the analysis of the fluid and include infections, pulmonary hypertension, neoplasms, heart failure, kidney disease, and cirrhosis. As a diagnostic aid, thoracentesis can be used to identify an unknown infection or one that is not responding to treatment. If an infection is suspected, a culture of the fluid is often done to determine the presence of microorganisms. Other conditions for which diagnostic thoracentesis may be used include leakage of blood into the pleural cavity (hemothorax), inflammation of the pancreas (pancreatitis), a blood clot in the artery of the lungs (pulmonary embolism), thyroid disease, asbestos-associated pleural effusion, drug reactions, and collagen vascular diseases.
Therapeutic thoracentesis is performed to relieve breathing difficulties by removing the excess fluid caused by pleural effusion. It may be helpful in such conditions as heart failure, malignancy, inflammations, infections, or effects associated with pneumonia. Additionally, sometimes it can also be used to introduce different agents (e.g., sclerosing agents or agents for prevention/inhibition of cancers) directly into the pleural space, once the fluid has been removed. |
Source: Medical Disability Advisor
| In order for the procedure to be performed correctly, the pleural effusion must be localized by either a physical examination (which would reveal dull sound on percussion where the fluids are located); chest x-rays; or sometimes ultrasound, CT scan, or fluoroscopy. Additionally, blood tests might be done to determine if the individual has any problems with blood clotting.
Once the area with pleural effusion is identified, the procedure is typically performed while the individual is in a sitting position. A needle is inserted into the body from the back, at the upper border of one of the lower ribs (usually 5 to 10 cm away from the spine and below the point where the dull sounds were heard on percussion). Local anesthesia is then applied to the skin and tissues under the skin. Once pleural fluid is found on aspiration, the needle is changed to a needle with a larger bore (inner circumference) so that the fluid can easily be drawn out through connecting tubing and into a container. Usually around 100 ml of fluid is withdrawn if a diagnostic thoracentesis is being performed, and up to 1,500 ml or more for a therapeutic thoracentesis.
Once the needle is withdrawn from the chest after the procedure is completed, a small bandage is applied to the puncture site, and the individual may need to lie on his or her side for about an hour or longer. This is sometimes necessary to facilitate the sealing of the puncture site. Once the procedure is completed, it is usually followed by a chest x-ray to make sure no complications have developed as the result of thoracentesis. The x-ray will also help to demonstrate the effectiveness of a therapeutic thoracentesis, and may also reveal lung abnormalities that had been hidden by the accumulated fluid.
This procedure is not routinely performed if the individual cannot cooperate (as a result of loss of consciousness, anxiety, compromised mental state, or combativeness), has grossly abnormal blood clotting, has a lower than normal number of platelets (thrombocytopenia), or has an unstable respiratory or cardiac condition.
Following the removal of the needle, a chest x-ray is usually performed to assure that no pneumothorax has been caused by the procedure. |
Source: Medical Disability Advisor
| Diagnostic thoracentesis will give the doctor information about the condition of the pleural cavity. It will also help to reveal the nature of any pleural disease. The outcome of tests guides the physician in making an appropriate diagnosis of the underlying cause for the increased fluid. The results of the procedure will guide the selection of treatment for the pleural effusion.
The use of therapeutic thoracentesis as treatment for fluids surrounding the lungs generally relieves the symptoms, but it may not always be curative (e.g., in malignancy or congestive heart failure). Therefore, outcomes will vary, depending on the condition responsible for development of pleural effusion. |
Source: Medical Disability Advisor
| Possible complications of the procedure include collapsed lung (pneumothorax), reaccumulation of the fluid, pulmonary edema, bleeding, infection, respiratory distress, puncture of the spleen or liver, air embolism, and fainting (simple or vasovagal syncope). Death may also occur, but it is extremely rare. |
Source: Medical Disability Advisor
| Work restrictions or accommodations depend on the individual's job requirements. Strenuous activity or heavy lifting will have to be modified temporarily. |
Source: Medical Disability Advisor
| Tamura, M., Yasuhito Ohta, and H. Sata. "Thorascopic Appearance of Bilateral Spontaneous Pneumothorax." Chest 124 6 (2003): 2363-2371. |
Source: Medical Disability Advisor
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