ULTRASOUND-guided thoracentesis

Non-ultrasound-guided thoracentesis can have serious complications such as pneumothorax, reported between 20 and 39%. This complication can be reduced to 0% when the procedure is guided by ultrasonography.

Ultrasound is a safe, fast, and effective procedure to define the specific site of catheter or probe placement for drainage of pleural fluid, being able to identify adjacent structures such as the diaphragm, lung parenchyma, or abdominal viscera. Ideally, it should be performed by the specialist at the same time as the thoracentesis, since a reduction in the incidence of pneumothorax has not been seen when the thoracic puncture is performed by the radiologist.

Indications

1. Diagnostic: each fluid in the pleural cavity of unknown etiology, with the exception of patients in whom the clinical symptoms and the results of the complementary examinations suggest heart failure, dialysis patients, with hypoalbuminemia and / or liver cirrhosis (in these patients the puncture is indicated in case of lack of improvement after the applied treatment, as well as in case of fever, pleural pain or large amount of unilateral fluid).

2. Therapeutic: symptomatic compression of the lung by fluid in the pleural cavity (generally ≥1500 ml of fluid is not removed at one time).

Contraindications

1. Absolute: they do not exist.

2. Relative: INR> 1.5 and aPTT> 2 × ULN, platelets <50,000 / µl, small amount of fluid (does not guarantee safe puncture), or skin infection at the planned puncture site.