AJR Am J Roentgenol 1998 Apr;170(4):943-6
Asymptomatic hydropneumothorax after therapeutic thoracentesis
for malignant pleural effusions.
Boland GW, Gazelle GS, Girard MJ, Mueller PR
Department of Radiology, Massachusetts General Hospital, Harvard Medical School,
Boston 02114, USA.
OBJECTIVE: The purpose of this study was to document in a historical cohort the
incidence and clinical observations of pneumothorax ex vacuo after therapeutic
thoracentesis for malignant pleural effusions in patients with underlying
parenchymal lung disease. MATERIALS AND METHODS: Forty pneumothoraces resulted
from 512 therapeutic thoracentesis performed for malignant pleural effusions
over a 3-year period. Twenty-nine patients with pneumothoraces underwent
catheter placement in the pleural space for treatment. Of these, 12
pneumothoraces resolved and 17 remained unchanged. We reviewed the charts of
these 17 patients to document the cause of malignant pleural effusion, presence
of underlying malignant parenchymal disease, volume of fluid aspirated, and
improvement in symptoms. Clinical outcome was then evaluated, including size of
residual pneumothorax, duration of catheter drainage, and reaccumulation of
effusion. RESULTS: No patients' lungs reexpanded despite insertion of large-bore
(16- to 35-French) chest tubes. All had pneumothoraces that occupied at least
30% of the hemithorax; all were asymptomatic; all had underlying parenchymal
disease and noncompliant lungs. Pleural effusion reaccumulated in all 17 after
removal of the chest tube. CONCLUSION: A subgroup of patients with malignant
lung parenchymal disease who undergo therapeutic thoracentesis will develop
asymptomatic hydropneumothoraces due to poor lung compliance. These patients do
not require further catheter drainage. Pleural effusion will reaccumulate in the
residual space over a variable period of time.
PMID: 9530040, UI: 98191070
