Which devices are used as guidance in a diagnostic thoracentesis the workup for pleural effusions (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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In patients with large, freely flowing effusions and no relative contraindications to thoracentesis, diagnostic thoracentesis can usually be performed safely, with the puncture site initially chosen based on the chest radiograph and located 1-2 rib interspaces below the level of dullness to percussion on physical examination. In other situations, ultrasonography or chest CT scanning should be used to guide thoracentesis.

Ultrasonography guidance at bedside significantly increases the likelihood of obtaining pleural fluid and reduces the risk of pneumothorax. [30, 37]  A postprocedure chest film may not be needed, but it is always a good practice to look for ultrasonic evidence of a pneumothorax. The presence of lung sliding would confirm the absence of a pneumothorax.

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