Abstract No. 577 Limited clinical utility of chest radiography in asymptomatic patients after interventional radiology-performed ultrasound-guided thoracentesis: analysis of 3022 consecutive patients

Abstract

To report the utility of chest radiography following interventional radiology (IR)–performed ultrasound-guided thoracentesis. A total of 3998 patients underwent thoracentesis between 2003-2018 at two institutions. A total of 3022 (75.6%) patients were >18 years old, underwent IR-performed ultrasound-guided thoracentesis, and had same-day post procedure chest radiograph evaluation. Patient age (years), laterality of thoracentesis, procedural technical success, volume of fluid removed (mL), method of post procedure chest imaging, absence or presence of pneumothorax, pneumothorax size (mm), pneumothorax management measures, and clinical outcomes were recorded. IR-performed ultrasound-guided thoracentesis was performed on the left (n = 1531; 50.7%), right (n = 1477; 48.9%), and bilaterally (n = 14; 0.5%) using 5-French catheters. Technical success was 100% (n = 3022). Mean volume of 940 ± 550 mL of fluid was removed. Postprocedural pneumothorax was identified in 21 (0.69%) patients. Mean pneumothorax size, measured on chest radiograph as the longest distance from the chest wall to the lung pleural reflection, was 18.8 ± 10.2 mm (range, 5.0-35.0 mm). Of the 21 pneumothoraces, 7 (33.3%) resolved spontaneously and had a mean size of 6.4 ± 2.4 mm. Fourteen pneumothoraces, of mean size 25.0 ± 5.8 mm, required management with a pleural drainage catheter (66.6%). The overall incidence of pneumothorax requiring pleural drainage catheter placement following IR-performed ultrasound-guided thoracentesis was 0.46% (14/3022). Of the patients requiring drainage catheter placement, 12/14 (85.7%) and 13/14 (92.9%) had dyspnea and hypoxia, respectively. Potential costs to Medicare and Medicaid, for chest radiographs, in this study, were $27,547 and $10,581, respectively. The incidence of clinically significant pneumothorax requiring catheter drainage is exceedingly low (0.46%), and routine post procedure chest radiographs in asymptomatic patients provide little value. Reserving post procedure chest radiographs for patients with post procedure dyspnea or hypoxia will result in more efficient resource utilization and health care cost savings.Table 1Thoracenteses and Post-Procedural Chest Radiograph ResultsVariableOutcomeLaterality of EffusionLeft1,531 (50.7%)Right1,477 (48.9%)Bilateral14 (0.5%)Mean Volume Removed940 mL (550 mL)Chest Radiograph Technique Portable78 (2.6%)One View513 (17.0%)Two Views2,355 (77.9%)Three Views76 (2.5%)Post-Procedural Pneumothorax21 (0.69%)Mean Pneumothorax Size18.8 (10.2 mm) Open table in a new tab