Thoracentesis (THOR-ah-sen-TE-sis) is a procedure to remove excess fluid in the space between the lungs and the chest wall. This space is called the pleural space.
Normally, the pleural space is filled with a small amount of fluid—about 4 teaspoons full. Some conditions—such as heart failure, lung infections, and tumors—can cause more fluid to build up. When this happens, it's called a pleural effusion (PLUR-al e-FU-shun). A lot of extra fluid can press on the lungs, making it hard to breathe.
Doctors use thoracentesis to find the cause of a pleural effusion. The procedure also might be done to help you breathe easier.
During the procedure, your doctor inserts a thin needle or plastic tube into the pleural space. He or she draws out excess fluid.
Your doctor may take only the amount of fluid needed to find the cause of the pleural effusion. However, if you have a lot of fluid in your pleural space, he or she may take more. This helps the lungs expand and take in more air, which allows you to breathe easier.
After the fluid is removed from your chest, it's sent for testing. Once the cause of the pleural effusion is known, your doctor will plan treatment. For example, if an infection is causing the excess fluid, your doctor may prescribe antibiotics. If the cause is heart failure, you'll be treated for that condition.
Thoracentesis usually takes 10–15 minutes. It may take longer if you have a lot of fluid in your pleural space. You'll be watched for up to a few hours after the procedure for complications.
Thoracentesis usually doesn't cause serious problems, but some risks are involved. Risks include:
Sometimes these problems get better on their own. If not, your doctor will likely prescribe treatment.
Your doctor may recommend thoracentesis if you have a pleural effusion. A pleural effusion is the buildup of excess fluid in the pleural space (the space between the lungs and chest wall).
Doctors use thoracentesis to find the cause of a pleural effusion. The procedure also might be done to remove excess fluid from the pleural space and help you breathe easier.
The most common cause of a pleural effusion is heart failure. This is a condition in which the heart can't pump enough blood to the body.
Other causes include lung cancer, tumors, pneumonia, tuberculosis, pulmonary embolism (PULL-mun-ary EM-bo-lizm), and other lung infections. Asbestosis (as-bes-TOE-sis), sarcoidosis (sar-koy-DO-sis), and reactions to some drugs also can lead to a pleural effusion.
Your doctor will diagnose a pleural effusion based on your medical history, a physical exam, and test results.
Your doctor will ask about your symptoms, such as trouble breathing, coughing, and hiccups. He or she also may ask whether you've ever:
Your doctor will listen to your breathing with a stethoscope and tap lightly on your chest. If you have a pleural effusion, your breathing may sound muffled. Your doctor also may hear a dull sound when tapping on your chest.
You may have one or more of the following tests to diagnose a pleural effusion.
Before thoracentesis, your doctor will talk to you about the procedure and how to prepare for it. Tell your doctor:
No special preparations are needed before thoracentesis.
Thoracentesis is done at a doctor's office or hospital. The entire procedure (including preparation) usually takes 10–15 minutes, but the needle or tube is in your chest for only a few minutes during that time. If you have a lot of fluid in your pleural space, the procedure may take up to 45 minutes.
You'll sit on the edge of a chair or exam table, lean forward, and rest your arms on a table. You'll be asked to not move, cough, or breathe deeply once the procedure begins.
Your doctor may use ultrasound to find the right place to insert the needle or tube. Ultrasound uses sound waves to create a picture of the structures in your body, such as your lungs.
Your doctor will clean the area on your skin where the needle or tube will be inserted. Then, he or she will inject medicine to numb the area. You may feel some stinging at this time.
Your doctor will insert the needle or tube between your ribs and into the pleural space (the space between the lungs and chest wall). You may feel some discomfort and pressure at this time.
Using the needle or tube, your doctor will draw out the excess fluid around your lungs. You may feel like coughing, and you may feel some chest pain.
Your doctor may take only the amount of fluid needed to find the cause of the pleural effusion. However, if you have a lot of fluid in your pleural space, he or she may take more. This helps the lungs expand and take in more air, which allows you to breathe easier.
Once the fluid is removed, your doctor will take out the needle or tube. He or she will place a small bandage on the site where the needle or tube was inserted.
After thoracentesis, you may have a chest x ray to check for any lung problems. Your blood pressure and breathing will be checked for up to a few hours after the procedure. This is done to make sure you don't have complications.
Your doctor will let you know when you can return to your normal activities, such as driving, physical activity, and working.
Once at home, call your doctor right away if you have any breathing problems.
Your doctor will send the fluid removed during thoracentesis for testing. The fluid will be checked for signs of heart failure, infection, cancer, or other conditions that may cause a pleural effusion (the buildup of fluid between the lungs and chest wall).
Once the cause of the pleural effusion is known, your doctor will talk to you about a treatment plan. For example, if an infection is the cause, you may need antibiotics to fight the infection. If the cause is heart failure, you'll be treated for that condition.
The risks of thoracentesis usually are minor. They include:
Your doctor may do a chest x ray after the procedure to check for lung problems.
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