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Lee, Choi, Yu, Suh, Kim, Ahn, Chung, Park, Kim, Kim, Kim, Lee, and Heo: Diagnostic Approach to a Patient with a Pleural Effusion Including Ultrasound-guided Paracentesis Performed by a Medical Resident
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 64(6): 439-444.

Published online: 30 June 2008

DOI: https://doi.org/10.4046/trd.2008.64.6.439

Diagnostic Approach to a Patient with a Pleural Effusion Including Ultrasound-guided Paracentesis Performed by a Medical Resident

Yun Young Lee, M.D.1, Won Je Choi, M.D.1, Chang Min Yu, M.D.1, Seong O Suh, M.D.1, Eun Sil Kim, M.D.1, Seok Jin Ahn, M.D.1, Jun-Oh Chung, M.D.1, Sang Joon Park, M.D.1, Yun Kwon Kim, M.D.1, Soyon Kim, M.D.1, Young Jung Kim, M.D.1, Se Han Lee, M.D.1, Heon Heo, M.D.2

1Department of Internal Medicine, National Police Hospital, Seoul, Korea.

2Department of Radiology, National Police Hospital, Seoul, Korea.

Address for correspondence: Sang Joon Park, M.D. Division of Pulmonology, Department of Internal Medicine, National Police Hospital, 58, Garakbon-dong, Songpa-gu, Seoul 138-708, Korea. Phone: 82-2-3400-1517, Fax: 82-2-3400-1213, 0021yu@hanmail.net

Received 23 February 2008       Accepted 11 June 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

A patient with a pleural effusion that is difficult to safely drain by a "blind" thoracentesis procedure is generally referred to a radiologist for ultrasound-guided thoracentesis. But such a referral increases the cost and the patient's inconvenience, and it causes delay in the diagnostic procedures. If ultrasound-guided thoracentesis is performed as a bedside procedure by a medical resident, then this will reduce the previously mentioned problems. So these patients with pleural effusions were treated by medical residents at our medical center, and the procedures included bedside ultrasound-guided thoracenteses.

Methods

We studied 89 cases of pleural effusions from March 2003 to June 2005. A "blind" thoracentesis was performed if the amount of pleural effusion was moderate or large. Bedside ultrasound-guided thoracentesis was performed for small or loculated effusions or for the cases that failed with performing a "blind" thoracentesis.

Results

"Blind" thoracenteses were performed in 79 cases that had a moderate or large amount of uncomplicated pleural effusions and the success rate was 93.7% (74/79 cases). Ultrasound-guided thoracentesis by the medical residents was performed in 15 cases and the success rate was 66.7% (10/15 cases). The 5 failedcases included all 3 cases with loculated effusions and 2 cases with a small amount of pleural effusion. All the failed cases were referred to one radiologist and they were then successfully treated. If we exclude the 3 cases with loculated pleural effusions, the success rate of ultrasound-guided thoracentesis by the medical residents increased up to 83% (10/12 cases). Two cases of complications (1 pneumothorax, 1 hydrohemothorax) occurred during ultrasound-guided thoracentesis.

Conclusion

Ultrasound-guided thoracentesis performed as a bedside procedure by a medical resident may be relatively effective and safe. If a patient has a loculated effusion, then it would be better to first refer the patient to a radiologist

Keywords: Ultrasound, Thoracentesis, Pleural effusion, Medical residency

Figures and Tables

Figure 1
Algorithm for diagnostic decision in evaluating patients with pleural effusion.
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Figure 2
Results of thoracentesis of patients with pleural effusion. n: the number of cases.
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Table 1
Characteristics of patients and pleural effusions
trd-64-439-i001

Data are presented as number unless otherwise indicated.

Table 2
Results of ultrasound-guided thoracenteses by medical residents
trd-64-439-i002

Data are presented as number unless otherwise indicated.

Table 3
Incidence of complication after thoracentesis according to the cause of effusion
trd-64-439-i003

Data are presented as number unless otherwise indicated.

Table 4
The association between thoracentesis complication and physician's experience
trd-64-439-i004

Data are presented as number.

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