Is routine chest radiography after thoracocentesis warranted?

Abstract

Thoracocentesis to evacuate pleural effusion is one of the most common procedures performed in Radiology Departments and is often done in the evening or during the night by radiologists on-call and who are often relatively inexperienced in radiology. Since complications such as pneumothorax may occur after interventional procedures, routine chest radiography is performed in most departments to detect these complications. Whether there is a need for routine chest radiography has long been questioned, because recent studies have shown a fairly low incidence of pneumothorax and other complications. The contribution of operator experience has also been questioned. In this issue of Acta Radiologica, Pihlajamaa et al. present a study reporting 264 ultrasonograhyguided pleural effusion evacuation procedures on 212 patients. Post-procedural chest radiography was performed after every procedure by several radiology residents with less than 2 years’ experience in radiology and by senior radiologists with between 5 and 15 years of experience in interventional radiology. Pneumothorax was disclosed in 11 of the 264 procedures, giving an incidence of 4.2%, and placement of a chest tube was considered necessary in only one case. Needle size was the only significant variable contributing to the incidence of pneumothorax. Variables such as mechanical ventilation or not, the presence or not of obstructive lung disease, the experience of the radiologist, or place where the procedure took place (radiology department/intensive care unit) had no influence on the pneumothorax. The overall results of the study indicate that routine chest radiography following evacuation of pleural effusion in not indicated. This study is an important contribution to the ongoing discussion on whether or not examinations should be performed routinely because ‘‘they have always been performed’’, without any thought being given to the rationale behind such examinations. This article is highly recommended reading and is a valuable contribution to the debate.