Different causes of post-thoracentesis pneumothorax
The emergence of pneumothorax ex vacuo as an important clinical consideration
Pneumothorax ex vacuo usually doesn't require any immediate treatment
Should we limit all thoracenteses to under one liter in efforts to decrease in the rate of pneumothorax ex vacuo?
The recommendation to limit the volume removed at thoracentesis in order to avoid pneumothorax may reflect a failure to appreciate the significance of pneumothorax ex vacuo. Not all post-procedure pneumothorax is created equal.
- There are many mechanisms of post-thoracentesis pneumothorax. With ultrasound guidance and excellent technique, most can be avoided except for pneumothorax ex vacuo. In expert hands, this becomes the most common cause of pneumothorax after therapeutic thoracentesis.
- Pneumothorax ex vacuo is important to recognize as a possible cause of pneumothorax following therapeutic thoracentesis. This is a benign entity which doesn't benefit from chest tube placement and can usually be observed.
- Although pneumothorax ex vacuo may possibly be avoided by performing small-volume thoracentesis, its unclear that this is a beneficial approach as it may leave the underlying problem (unexpandible lung) obscured.