PNEUMOTHORAX AFTER THORACENTESIS IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Objective: To determine whether the frequency of pneumothorax is incre ased after thoracentesis in chronic obstructive pulmonary disease pati ents. Design: Prospective. Setting: Northeastern community hospital. P atients: One-hundred-six patients underwent multiple thoracentesis; 36 patients had co-existent chronic obstructive pulmonary disease (mean age, 68.2 years). Chronic obstructive pulmonary disease was identified by radiologic findings consistent with chronic obstructive pulmonary disease and as forced expiratory volume in one second less than 70% of predicted. Outcome Measures: Identification of pneumothorax on chest roentgenogram after thoracentesis. Intervention: Patients had diagnost ic or therapeutic thoracentesis with follow-up chest radiography withi n 2 hours, or sooner if clinically indicated. Results: Patients with c hronic obstructive pulmonary disease had a higher incidence of pneumot horax (15 of 36 patients; 41.7%) than those patients without underlyin g chronic obstructive pulmonary disease (13 of 70 patients; 18.5%; p = 0.005). The frequency of pneumothorax was no different according to w ho performed the procedure (house staff or pulmonologist), whether it was for diagnostic or therapeutic reasons, and whether a small (<500 m l) or large (>500 ml) amount of fluid is removed. Conclusion: Pneumoth orax may frequently occur in patients with chronic obstructive pulmona ry disease undergoing thoracentesis. The reason may be related to the altered architecture of the lung parenchyma and the change in mechanic al forces in chronic obstructive pulmonary disease. Sonography-guided thoracentesis may offer a safer means of performing thoracentesis in p atients with chronic obstructive pulmonary disease.