Complications Of Thoracentesis Research Articles

Subcutaneous and muscle layer seroma complicated with thoracentesis.

Diagnostic thoracentesis is a basic and relatively safe diagnostic method for patients with pleural effusion. However, complications of thoracentesis are rare and not well known because of the low incidence. Herein, we report a case of subcutaneous and muscle layer seroma following thoracentesis.

Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis.

Thoracentesis and thoracoscopy are used to diagnose malignant pleural effusions (MPE). Data on how sensitivity varies with tumour type is limited. Systematic review using PubMed was performed through August 2020 to determine the sensitivity of thoracentesis and thoracoscopy for MPE secondary to malignancy, by cancer type, and complication rates. Tests to identify sources of heterogeneity were performed. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and National Institutes of Health quality assessment tools. Publication bias was tested using funnel plots. Meta-analyses for sensitivity of thoracentesis for MPE secondary to malignancy, mesothelioma and lung and breast cancer included 29, eight, 12 and nine studies, respectively. Pooled sensitivities were 0.643 (95% CI 0.592-0.692), 0.451 (95% CI 0.249-0.661), 0.738 (95% CI 0.659-0.836) and 0.820 (95% CI 0.700-0.917), respectively. For sensitivity of thoracoscopy for MPE secondary to malignancy and mesothelioma, 41 and 15 studies were included, respectively. Pooled sensitivities were 0.929 (95% CI 0.905-0.95) and 0.915 (95% CI 0.871-0.952), respectively. Pooled complication rates of thoracentesis and thoracoscopy were 0.041 (95% CI 0.025-0.051) and 0.040 (95% CI 0.029-0.052), respectively. Heterogeneity was significant for all meta-analyses. Funnel plots were asymmetric. Sensitivity of thoracentesis varied significantly per cancer type. Pooled complication rates were low. Awareness of how sensitivity of thoracentesis changes across cancers can improve decision-making when MPE is suspected.

Evaluation of the position of the needle tip during thoracentesis: Experimental study.

Introduction:Thoracentesis is performed to both diagnose and/or treat pleural effusion, and several important complications of thoracentesis are occasionally observed. To assess precise thoracentesis procedures, we evaluated the position of the needle tip during thoracentesis by using a thoracentesis unit, comparing experienced and inexperienced groups.Methods:Twenty eight physicians (19 board-certified pulmonologists as an experienced group and the remaining 9 as an inexperienced group) participated at Fukujuji Hospital in January 2021. All participants performed 2 punctures with a handmade thoracentesis unit and measured the needle‘s angle to the midline.Results:The median distance from the needle tip to the midline when the needle was inserted 5 cm (D5) was 0.47 cm (range 0.06–1.05), and the median difference between D5 on the 1st puncture (D51st) and D5 on the 2nd puncture (D52nd) was 0.22 cm (range 0.00–0.69). D5 was shorter in the experienced group than in the inexperienced group (median 0.40 cm (range 0.06–0.66) vs 0.58 cm (range 0.44–1.05), P < .001). There were no significant differences in the D51st and D52nd distances between the experienced and inexperienced groups (median 0.22 cm (range 0.00–0.40) vs 0.41 cm (range 0.04–0.69), P = .094). When 4 areas were divided by the x-axis and y-axis, 32 punctures (55.2%) deviated to the right-upper quadrant, and 25 (86.2%) of participants made the 1st puncture and 2nd puncture in the same direction.Conclusions:All doctors should know that the needle direction might shift by approximately 1 cm, and more than half of the practitioners punctured towards the upper right.

Complications of therapeutic thoracentesis with respect to time

Background : Thoracentesis can be done for both therapeutic and diagnostic purposes, with the objective of symptomatic relief and improve of quality of life due to dyspnoea. The underlying mechanism for symptom relief following thoracentesis is multifactorial but principally includes progress in respiratory muscle mechanics with a smaller effect from progress in lung volumes and pulmonary function. Materials and Methods: This is prospective and randomized study was carried out on 90 patients who were admitted to the Department of Pulmonary Medicine, Govt. Medical College and Hospital, Nizamabad during the period of February 2020 to October 2020. Inclusion Criteria: The patients with chest Xray features suggestive of pleural effusion and undergoing therapeutic thoracentesis. Exclusion Criteria: Patients known to have loculated effusion on ultrasonography and having bleeding diathesis were excluded from the study. Conclusions : Most complication of thoracentesis is unprecedented. Clinician consciousness of risk factors for procedural complexities and experience with techniques that improve results are fundamental segments for carefully performing thoracentesis. Keywords: Pneumothorax, Pulmonary oedema, Thoracentesis..

Thoracentesis under clopidogrel is not associated with excessive bleeding events: a cohort study

BackgroundThoracentesis is a low-risk procedure for bleeding (approx. 2%). Data regarding safety of thoracentesis under treatment with clopidogrel is scarce, and current guidelines are not evidence based. We performed a retrospective study to evaluate the rate of bleeding complications of thoracentesis under clopidogrel in hospitalized patients.MethodsRetrospective chart review of hospitalized patients undergoing thoracentesis with or without clopidogrel treatment. Demographic and clinical data, diagnostic ICD9 codes, and use of ultrasound were extracted. Bleeding endpoints were defined as hemothorax, drop of > 2 g/dL hemoglobin, or need for packed red cell transfusion.ResultsThe study group comprised of 88 cases and 169 controls. Four bleeding complications were noted in the cases group, versus 5 in the control group (RR 1.53, 95% CI 0.4–5.5).ConclusionThoracentesis may be performed safely in patients receiving clopidogrel. Bleeding event rates are consistent with previous reports of thoracentesis in general.

FATAL CONSEQUENCES OF THERAPEUTIC THORACENTESIS IN PATIENTS WITH SYSTEMIC SCLEROSIS

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Pulmonary complications are common and a leading cause of death in patients with systemic sclerosis (SSc). Pleural effusions, however, are rare. Thoracentesis is a common procedure, performed to reveal the cause of pleural effusion or to drain it and relieve dyspnea. Although generally considered a low-risk intervention, complications of thoracentesis can lead to increased morbidity and mortality. We Here by describe our experience with patients with SSc requiring therapeutic thoracentesis. CASE PRESENTATION: We describe three patients with SSc and symptomatic pleural effusion who required thoracentesis. All patients deteriorated shortly after the procedure and died. The patients all had advanced heart failure either from left heart disease and/or severe pulmonary hypertension. DISCUSSION: We assume that patients with SSc are at high-risk to develop complications after thoracentesis, most likely due to the low compliant lungs and the low elastance of the pleura, in addition to significant cardiac compromise as etiology for pleural effusions. CONCLUSIONS: Pleural effusion in patietns with SSc is associated with grave prognosis secondary to heart failure or pulmonary hypertension. In such patients thoracentesis should be done with caution, while measuring the pleural pressure, either invasively, or with noninvasive surrogates. Reference #1: Luo YF, Robbins IM, Karatas M, et al. Frequency of pleural effusions in patients with pulmonary arterial hypertension associated with connective tissue diseases. Chest 2011; 140:42-7. Reference #2: Thompsom AE and Pope JE. A study of the frequency of pericardial and pleural effusions in scleroderma. Br J Rheumatol 1998; 37:1320-3. Reference #3: Bouros D, Pneumatikos I, and Tzouvelekis A. Pleural involvement in systemic autoimmune disorders. Respiration 2008; 75:361-71. DISCLOSURES: no disclosure on file for Yair Levy; no disclosure on file for aiman Natur; no disclosure on file for Tsvi Sirotkin; No relevant relationships by ori wand, source=Web Response

MISSED INTRA-ABDOMINAL HEMATOMA FROM INTERCOSTAL ARTERY LACERATION DURING THORACENTESIS

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Hemorrhagic complications of thoracentesis are rare but life-threatening. We report a fatal case of intercostal artery (ICA) laceration during percutaneous thoracentesis, presenting as intra-abdominal hematoma diagnosed on bedside sonogram (US). CASE PRESENTATION: A 49-year-old female with end-stage renal disease, coronary artery bypass grafting on dual anti-platelet therapy (DAPT) was admitted for pneumonia. Despite 7 days of inpatient antibiotic treatment she remained hypoxic. Chest radiograph (CXR) showed complete opacification of left hemithorax. Bedside left percutaneous US guided thoracentesis was done which revealed fluid consistent with empyema. Post procedure CXR showed left lung re-expansion with no pneumothorax. Approximately 3 hours after procedure patient had a pulseless electrical activity cardiac arrest. After 3 minutes of resuscitation she was awake, responsive and transferred to the medical ICU. Initial laboratory values including hemoglobin (Hb), troponin and a repeat CXR were unchanged from prior. She remained hypotensive despite aggressive fluid resuscitation and maximal vasopressor support. A chest tube was inserted which drained 50ml of sero-sanguinous fluid. Repeat Hb approximately 6 hours after thoracentesis, revealed drop from 12 to 5gm/dl, requiring massive transfusion. On re-examination, her abdomen appeared distended and firm. Bedside US revealed a 19cm hypoechoic mass in left abdomen concerning for hematoma. Emergent CT angiogram showed contrast extravasation from left 10th ICA which was successfully embolized. Hemodynamics improved. Shortly after she developed abdominal compartment syndrome and DIC and unfortunately passed away. DISCUSSION: : Thoracentesis is a common procedure and considered low risk. Hemorrhage is usually from ICA laceration, and manifests as hemothorax, rarely as abdominal wall hematoma, but intra-abdominal hematoma have not been reported. Patients at risk are those with INR > 1.5-2, platelets <50,000/µl, advanced renal disease; anti-platelets are generally considered safe, though some studies report higher chest tube outputs especially with DAPT. ICA typically runs along the subcostal groove, however studies demonstrate increased exposure and tortuosity with advanced age, previous sternotomy, and caudal intercostal spaces. Some studies have noted utility of thoracic US in identifying ICA. Recent reports suggest the use of vascular US with color Doppler to visualize the ICA and its collaterals. These are yet to be universally adopted in clinical practice. US is helpful in quick bedside evaluation for location of bleed which is critical in unstable patients. CONCLUSIONS: Clinicians should be mindful of anatomical variations of ICA even in US guided thoracentesis. They should also consider abdominal bleeding and appropriately use the bedside US in suspected cases. Reference #1: Helm EJ, Rahman NM, Talakoub O, Fox DL. Course and Variation of the Intercostal Artery by CT Scan. Chest. 2013;143(3):634-639. https://doi.org/10.1378/chest.12-1285 Reference #2: Patel IJ, Davidson JC, Nikolic B, et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. JVIR. 23(6):727-736. https://doi.org/10.1016/j.jvir.2012.02.012 Reference #3: Kanai M, Sekiguchi H. Avoiding Vessel Laceration in Thoracentesis A Role of Vascular Ultrasound With Color Doppler. Chest. 2015;147(1):e5-e7. https://doi.org/10.1378/chest.14-0814. DISCLOSURES: No relevant relationships by Jayashri Bhaskar, source=Web Response No relevant relationships by Jyotirmayee Lenka, source=Web Response No relevant relationships by Laurie Lerner, source=Web Response No relevant relationships by Yetunde Ogunsesan, source=Web Response No relevant relationships by Naman Sharma, source=Web Response No relevant relationships by Qiu Tong, source=Web Response

Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial.

Physicians-in-training often perform bedside thoracenteses in academic medical centers, and complications are more common among less experienced clinicians. Simulation-based mastery learning (SBML) is one potential solution to this problem. This study evaluated the effects of a randomized trial of thoracentesis SBML on patient complications: iatrogenic pneumothorax (IP), hemothorax, and reexpansion pulmonary edema (REPE). The authors randomized internal medicine residents to undergo thoracentesis SBML at a tertiary care academic center from December 2012 to May 2016. They subsequently compared thoracentesis complications from procedures performed by SBML-trained residents, traditionally trained residents (no simulation training), and those referred to pulmonary medicine or interventional radiology (IR). During the study period, 917 thoracenteses were performed on 709 patients. IP occurred in 60 (6.5%) procedures, of which 7 (11.6%) were clinically meaningful. SBML-trained residents performed procedures with a trend toward lower combined clinically meaningful complications (IP, hemothorax, REPE) compared with traditionally trained residents (7.9% vs. 0%; P = .06). SBML-trained residents caused fewer clinically meaningful IPs compared with traditionally trained residents, pulmonary, and IR referrals (P = .02). Hemothorax occurred after 4 (0.4%) thoracenteses, and SBML-trained residents had a trend toward lower hemothorax (0) compared with other groups (P = .07). REPE occurred after 3 (0.3%) procedures, with no differences between groups. SBML-trained residents performed procedures with lower combined clinically meaningful complications compared with other groups (P = .008). Residents randomized to an SBML intervention performed thoracenteses with low rates of clinically meaningful complications. Rigorous education represents a successful quality improvement strategy.

Malignant Tension Hydrothorax with Mediastinal Shifting: Emergency Decompression of a Rare and Potentially Lethal Respiratory Condition

Introduction: A Tension Hydrothorax is defined as a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. In these patients the pleural volume increases the intrathoracic pressure to the point of compromising diastolic filling and cardiac output simulating a cardiac tamponade physiology. This is an uncommon yet potentially fatal medical emergency that if left untreated may lead to cardiac arrest. Early detection and rapid intervention of these patients prevents cardiorespiratory collapse. Case presentation: We present a two-case report of patients presenting with a malignant tension hydrothorax managed in the emergency room with ultrasound-guided decompression thoracentesis and the other patient with tube thoracostomy. Conclusion: Although these life-saving decompressive interventions appear simple, not having proper training is an independent factor for chest tube and thoracentesis complications. Courses and simulation training can benefit physicians to minimize potential complications when managing emergency conditions and pathologies such as a Tension hydrothorax which continues to be a medical challenge. Whether thoracentesis or thoracostomy is superior in managing this condition remains in debate and a clinical dilemma.

Thoracentesis in Cirrhotics (TiC Study): Incidence of Hemorrhagic Complications of Thoracentesis in Cirrhotic Patients

Thoracentesis in Cirrhotics (TiC Study): Incidence of Hemorrhagic Complications of Thoracentesis in Cirrhotic Patients

Complications of thoracentesis: incidence, risk factors, and strategies for prevention.

Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema. Recent data support the importance of operator expertise and the use of ultrasound in reducing the risk of iatrogenic pneumothorax. Although coagulopathy or thrombocytopenia and the use of anticoagulant or antiplatelet medications have traditionally been viewed as contraindications to thoracentesis, new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk. Re-expansion pulmonary edema, a rare complication of thoracentesis, is felt to result in part from the generation of excessively negative pleural pressure. When and how to monitor changes in pleural pressure during thoracentesis remains a focus of ongoing study. Major complications of thoracentesis are uncommon. Clinician awareness of risk factors for procedural complications and familiarity with strategies that improve outcomes are essential components for safely performing thoracentesis.

Unilateral re-expansion pulmonary edema following drainage of spontaneous massive pneumothorax of short duration

Re-expansion pulmonary edema (RPE) is a rare complication of thoracentesis. Mortality has been reported in 20% of cases. We present a 25-year-old male with 2 days history of right sided chest pain with imaging suggestive of right-sided extensive pneumothorax. Patient developed symptoms consistent with RPE 12 h after placement of intercostal tube which was documented by imaging. Patient received symptomatic management in respiratory care ward with improvement of his symptoms within 24 h and normalization of chest X-ray after 3 days.

Does this patient have an exudative pleural effusion? The Rational Clinical Examination systematic review.

Thoracentesis is performed to identify the cause of a pleural effusion. Although generally safe, thoracentesis may be complicated by transient hypoxemia, bleeding, patient discomfort, reexpansion pulmonary edema, and pneumothorax. To identify the best means for differentiating between transudative and exudative effusions and also to identify thoracentesis techniques for minimizing the risk of complications by performing a systematic review the evidence. We searched The Cochrane Library, MEDLINE, and Embase from inception to February 2014 to identify relevant studies. We included randomized and observational studies of adult patients undergoing thoracentesis that examined diagnostic tests for differentiating exudates from transudates and evaluated thoracentesis techniques associated with a successful procedure with minimal complications. Two investigators independently appraised study quality and extracted data from studies of laboratory diagnosis of pleural effusion for calculation of likelihood ratios (LRs; n = 48 studies) and factors affecting adverse event rates (n = 37 studies). The diagnosis of an exudate was most accurate if cholesterol in the pleural fluid was greater than 55 mg/dL (LR range, 7.1-250), lactate dehydrogenase (LDH) was greater than 200 U/L (LR, 18; 95% CI, 6.8-46), or the ratio of pleural fluid cholesterol to serum cholesterol was greater than 0.3 (LR, 14; 95% CI, 5.5-38). A diagnosis of exudate was less likely when all Light's criteria (a ratio of pleural fluid protein to serum protein >0.5, a ratio of pleural fluid LDH to serum LDH >0.6, or pleural fluid LDH >two-thirds the upper limit of normal for serum LDH) were absent (LR, 0.04; 95% CI, 0.02-0.11). The most common complication of thoracentesis was pneumothorax, which occurred in 6.0% of cases (95% CI, 4.0%-7.0%). Chest tube placement was required in 2.0% of procedures (95% CI, 0.99%-2.9%) in which a patient was determined to have radiographic evidence of a pneumothorax. With ultrasound, a radiologist's marking the needle insertion site was not associated with decreased pneumothorax events (skin marking vs no skin marking odds ratio [OR], 0.37; 95% CI, 0.08-1.7). Use of ultrasound by any experienced practitioner also was not associated with decreased pneumothorax events (OR, 0.55; 95% CI, 0.06-5.3). Light's criteria, cholesterol and pleural fluid LDH levels, and the pleural fluid cholesterol-to-serum ratio are the most accurate diagnostic indicators for pleural exudates. Ultrasound skin marking by a radiologist or ultrasound-guided thoracentesis were not associated with a decrease in pneumothorax events.

Hemorrhagic Complications of Thoracentesis and Small-Bore Chest Tube Placement in Patients Taking Clopidogrel

Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established. We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure. Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax. There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure. Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy.

Evaluating Clinical Predictors of Complications of Thoracentesis

Evaluating Clinical Predictors of Complications of Thoracentesis

Conservative management of bronchopulmonary artery perforation without associated haemothorax occurring at thoracentesis: a case report

Puncture or laceration of the pulmonary, intercostal, or peripheral vessels is an uncommon, but potentially life-threatening, complication of thoracentesis, which has been reported to result in severe haemothorax in 75% of patients. Damage to these vessels typically requires surgical intervention or intra-arterial embolisation. We report the successful non-surgical management of an unusual case of pulmonary artery perforation without concomitant haemothorax in an 82-year-old man who underwent thoracentesis.

Pneumothorax Following Thoracentesis

Little is known about the factors related to the development of pneumothorax following thoracentesis. We aimed to determine the mean pneumothorax rate following thoracentesis and to identify risk factors for pneumothorax through a systematic review and meta-analysis. We reviewed MEDLINE-indexed studies from January 1, 1966, through April 1, 2009, and included studies of any design with at least 10 patients that reported the pneumothorax rate following thoracentesis. Two investigators independently extracted data on the pneumothorax rate, risk factors for pneumothorax, and study methodological quality. Twenty-four studies reported pneumothorax rates following 6605 thoracenteses. The overall pneumothorax rate was 6.0% (95% confidence interval [CI], 4.6%-7.8%), and 34.1% of pneumothoraces required chest tube insertion. Ultrasonography use was associated with significantly lower risk of pneumothorax (odds ratio [OR], 0.3; 95% CI, 0.2-0.7). Lower pneumothorax rates were observed with experienced operators (3.9% vs 8.5%, P = .04), but this was nonsignificant within studies directly comparing this factor (OR, 0.7; 95% CI, 0.2-2.3). Pneumothorax was more likely following therapeutic thoracentesis (OR, 2.6; 95% CI, 1.8-3.8), in conjunction with periprocedural symptoms (OR, 26.6; 95% CI, 2.7-262.5), and in association with, although nonsignificantly, mechanical ventilation (OR, 4.0; 95% CI, 0.95-16.8). Two or more needle passes conferred a nonsignificant increased risk of pneumothorax (OR, 2.5; 95% CI, 0.3-20.1). Iatrogenic pneumothorax is a common complication of thoracentesis and frequently requires chest tube insertion. Real-time ultrasonography use is a modifiable factor that reduces the pneumothorax rate. Performance of thoracentesis for therapeutic purposes and in patients undergoing mechanical ventilation confers a higher likelihood of pneumothorax. Experienced operators may have lower pneumothorax rates. Patient safety may be improved by changes in clinical practice in accord with these findings.

Induction of pleural empyema in rats by thoracentesis with intrapleural pressure monitoring.

Our objective was to evaluate experimental induction of empyema in rats by intrapleural inoculation of Staphylococcus aureus by means of thoracentesis with pleural pressure monitoring. Forty female albino Wistar rats, anesthetized with droperidol and fentanyl, underwent intrapleural inoculation of a 0.2-ml solution. Group I ( N=25) received 10(10) colony-forming units/ml of Staphylococcus aureus cultivated in brain-heart infusion agar (BHI); group II (N = 15), the control group, received sterile BHI agar. Rats were inoculated after right hemithorax thoracentesis with a needle connected to an oscilloscope for pressure monitoring to confirm that the needle was inside the pleural space. Animals were killed after 3 (groups Ia and IIa) to 5 (groups Ib and IIb) days with sodium pentobarbital. The macroscopic changes, amount of pleural fluid, and anatomopathological aspects of pleura and lungs were recorded, as well as death causes and bacteriological findings of pleural fluid for animals that died before the time established for euthanasia. In group I, three animals died of thoracentesis complications, and five others died in the first 24 h due to septicemia; blood and spleen cultures isolated the bacteria previously inoculated. In group II, there was one death of unknown cause. Of the 17 rats inoculated with bacteria, nine (group Ia) were killed on the 3rd day; all had bacteria in pleural fluid (volume 0.5-3.8 ml). The other eight rats (group Ib) were killed on the 5th day; three (39.5%) had pleural fluid with bacteria (0.5-1.5 ml), and five (60.5%) had no pleural fluid. Rats from group II killed on the 3rd (group IIa) and 5th (group IIb) days had no pleural fluid. Pathologic examination revealed inflammatory infiltrate (93.75%) and fibrin (18.75%) in pleura, and inflammatory interstitial infiltrate (12.5%) in the right lung in group I; no changes were observed in 93.3% of the lungs in group II. Macroscopic examination revealed only turbid and bloody pleural fluid (class I) without pleural adhesions. Pleural inflammatory infiltrate was found in rats that received the bacteria but had no fluid at necropsy (class 0). One control rat, although with no clinical signs of disease or pleural fluid, had signs of pleural and pulmonary infection at necropsy. We conclude that empyema may be induced in rats by the inoculation of Staphylococcus aureus by means of thoracentesis with pleural pressure monitoring. The highest amount of pleural fluid was observed 3 days after bacterial inoculation.

Usefulness and complications of thoracentesis in cirrhotic patients

About 10% of cirrhotic patients with ascites have an associated pleural effusion as a result of passage of ascites through the diaphragm. This effusion, called hepatic hydrothorax, has the characteristics of a transudate (1–3). In patients with hydrothorax, spontaneous bacterial empyema can develop (4,5), and has been reported in 13% of hospitalized patients with cirrhosis and pleural effusions (5). Although thoracentesis and pleural fluid analysis are the only reliable ways to diagnose spontaneous bacterial empyema, the safety of thoracentesis for cirrhotic patients is not well established. Spontaneous bacterial empyema may actually be underreported because physicians are reluctant to perform thoracentesis, fearing complications, or because they do not believe that thoracentesis is necessary. We therefore prospectively evaluated the safety and utility of pleural fluid analysis in cirrhotic patients.

Contralateral Reexpansion Pulmonary Edema

Reexpansion pulmonary edema (RPE) is an unusual complication of thoracentesis. Significant morbidity can result, and death is reported in 20% of cases. It is typically manifested as edema within a lung that has recently been reexpanded. Few reports document contralateral edema formation. We present a case of recurrent left-sided pulmonary edema after repeated drainage of a right-sided pleural effusion due to hepatic hydrothorax. We believe this is the first reported case of recurrence and only the fifth overall case of contralateral RPE. We also review the pathophysiology, treatment, and case reports of contralateral RPE. Physicians should be aware of the complications of thoracentesis, particularly RPE, given the significant morbidity and mortality associated with it.