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When is thoracentesis an emergency procedure?

When thoracentesis isn't enough, needle decompression or chest tube placement may be used in emergencies

Around 1.5 million people will develop a pleural effusion each year in the United States. Before delving into the significance of this medical condition, it may be helpful to discuss some basic anatomy and physiology.

The pleura is a double-layered membrane that lines the lungs and the inner part of the chest wall, allowing them to move and slide together during respiration. The pleural space is the gap between the pleura of the lung and the inner chest wall.

Pleural effusion occurs when an excessive amount of fluid accumulates in the pleural space. Pleural effusion makes it more difficult to breathe by mechanically restricting the ability of the lungs to inflate fully, causing shortness of breath from inadequate oxygenation. Pleural effusion also increases pressure on the trachea and heart and can interfere with their function.

Causes of pleural effusion

Most of the cases of pleural effusion are caused by one of these underlying medical conditions:

• Congestive heart failure (CHF)

• Pneumonia

• Malignant cancer

• Pulmonary embolism (a clot traveling through the bloodstream to the lungs)

The medical literature has long reflected that there’s a high mortality (death) rate for patients with pleural effusions caused by malignancy. One study of patients hospitalized with a diagnosis of pleural effusion concluded that there is an overall (all causes) mortality rate of 15%, with a 12-month overall mortality rate of 32%.

Non-emergency treatment

Thoracentesis is a procedure where a needle is inserted through the chest wall into the pleural space to remove excess fluid. Around 180,000 thoracentesis procedures are performed annually in the United States.

The American Thoracic Society adopted guidelines for thoracentesis and needle biopsy of the pleura in 1988. According to the guidelines, the indications or reasons for thoracentesis include:

• Any undiagnosed pleural effusion where the cause cannot be reasonably deduced from clinical circumstances.

• To relieve symptoms because of large thoracentesis. This is called therapeutic thoracentesis and may involve repeated thoracentesis when pleural effusion fluid re-accumulates.

Fluid located in the pleural space restricts full lung re-expansion, which causes shortness of breath and makes it difficult to get adequate oxygen. When symptoms are worsening or severe, emergency decompression may be necessary.

Emergency treatment

While thoracentesis isn't considered an emergency procedure, sometimes clinical situations are such that fast action is required.

For instance, a hybrid condition called hydropneumothorax is where there’s a mix of fluid and air trapped in the pleural space. When there's a tension component to hydropneumothorax (or pneumothorax, meaning without fluid), emergency needle decompression or chest tube placement may be needed to prevent displacing key structures and organs necessary for cardiopulmonary function.

Prompt recognition of treatment of these conditions can mean the difference between life and death, or survival with a permanent brain injury, in emergency room or intensive care unit (ICU) settings.

If you’ve been seriously injured because of the delay in diagnosis and treatment of pleural effusion or tension pneumothorax in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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