CHEST ROENTGENOGRAPHY AFTER OUTPATIENT THORACENTESIS

Objective: To evaluate the clinical utility of posteroanterior chest r oentgenograms after thoracentesis in the outpatient setting. Design.: We undertook a retrospective study of clinical records of outpatient t horacenteses performed between January and December 1996 by the Divisi on of Pulmonary and Critical Care Medicine at Mayo Clinic Rochester. M aterial and Methods: The medical records of 54 men and 39 women who un derwent 123 outpatient thoracenteses mere reviewed, Exclusion criteria were the need for pleural biopsy at time of thoracentesis or the need for ultrasound-guided assistance for completion of the procedure. Ind ications for thoracentesis and postthoracentesis chest roentgenography were analyzed. Results: Of 123 thoracenteses performed in the outpati ent setting during the specified study period, 104 met the inclusion c riteria. Of these 104 thoracenteses, 54 (52%) were followed by chest r oentgenography. Pneumothorax occurred in only 5 of these 104 procedure s (5%), in 5 separate patients, Three of these patients were asymptoma tic and did not require therapeutic in intervention; the two symptomat ic patients required hospitalization and chest tube drainage. Of the t wo pneumothoraces in patients with symptoms, one was detected on the s ame day as the thoracentesis, and the other was diagnosed 2 days later . The patients who did not undergo postthoracentesis chest roentgenogr aphy had no reported complications. Of the 54 chest roentgenograms, 52 were obtained in asymptomatic patients, with no suspicion of pneumoth orax. These x-ray studies led to a total cost of $4,862 and detection of three pneumothoraces that did not require therapy. Conclusion: Rout ine performance of chest roentgenography after outpatient thoracentesi s can incur substantial cos., A more selective approach to this practi ce is needed, both to optimize patient care and to manage limited medi cal resources efficiently, Postthoracentesis chest roentgenograms shou ld be limited to patients with symptoms indicative of thoracentesis-in duced pneumothorax.