Pulmonary effusion, thoracentesis, collapsed lung, and medical malpractice

I am getting ready to file a wrongful death medical malpractice lawsuit in Harris County, Houston, Texas, involving a woman who had thoracentesis complications at a hospital in Cypress, Texas.

As a Houston, Texas medical malpractice attorney, it has taken a lot of time to decide the correct people to sue because so many healthcare providers gave shoddy, inattentive care to this patient.

The nurses couldn’t reach a surgeon for several critical hours.

When the patient would not arouse from anesthesia and had dangerously-low oxygen levels, the certified registered nurse anesthetist (CRNA) and anesthesiologist didn’t insert a breathing tube (intubation) and give supplemental oxygen.

Intensive care unit (ICU) doctors didn’t treat her poor oxygenation and hypoxia until it was too late.

Respiratory therapists didn’t speak up and say that the treatments weren’t working.

And then, of course, a massive bleed after thoracentesis, which is an exceptionally rare in and of itself.

What is thoracentesis?

To understand thoracentesis, we should start with what it’s intended to treat.

The pleura is a membrane that lines the surface of your lungs on one side and the inside of your chest wall on the other side. There is normally a small amount of fluid between the pleura and the lungs. When there is too much fluid in that space, it is called “pleural effusion” (water on the lungs), and can make it hard to breathe.

Thoracentesis is a common procedure to drain that excess fluid, done about 170,000 times a year in the United States. Thoracentesis involves inserting a very large needled—a  critical care expert that I am using to review this case describes it as the size of a chest pick—through the chest wall into the pleural space between the chest wall and the affected lung to drain the fluid.

Many types of physicians, including interventional radiologists, critical care physicians, and pulmonologists, perform thoracentesis in either an office or hospital setting, where it can be done bedside. It’s common to use ultrasound guidance to find the best place to insert the needle.

Once the fluid is removed, it is sent to a laboratory for analysis. The goal of the lab work is to find the cause of the fluid build-up, which will help the medical team pick the correct treatment.

Complications of thoracentesis

First of all, thoracentesis is considered a pretty safe procedure, particularly when the physician uses ultrasound guidance.

The most common complication is iatrogenic pneumothorax (collapsed lung from medical care). In fact, this complication is so common that many doctors do a post-procedure chest x-ray to look for pneumothorax. Another term for a fully or partially collapsed lunch is atelectasis. Other complications include re-expansion pulmonary edema, bleeding episodes, and vasovagal reactions.

Hemothorax , a collection of blood in the pleural cavity (between the chest wall and the lung), rarely happens in conjunction with thoracentesis.

Treating hemothorax and hemoptysis

In the case I’m working on, an interventional radiologist performed thoracentesis on the patient under ultrasound guidance. There were no signs of pneumothorax after the procedure.

Shortly later, though, the patient had violent hemoptysis, which is coughing up blood and clots. The medical literature reflects that this is an extremely rare complication related to injury to the lung itself. In other words, the physician inserted the needle too far, going past the pleural space directly into the lung.

The critical care medical expert reviewing this case for us described it like this, “It’s like being stabbed in the lung with an ice pick.” It’s easy to see where all that blood came from that the patient was coughing up.

Any time there is hemothorax and hemoptysis, the standard of care requires an emergency placement of a chest tube to drain the blood, and placement of a breathing tube (intubation) to prevent the patient from aspirating (breathing  in) the blood.

While she should have been intubated and given supplemental oxygen as soon as she was admitted to the ICU, it took this accidental laceration of her lung to get her the care that she needed all along. Although the medical team finally adequately responded after the patient began spitting up blood, it was too late for her.

We are here to help

If you or a loved one has been seriously injured by medical malpractice, then the experienced  thoracentesis and lung collapse attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.


Robert Painter is a 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 against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys 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 for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.