Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest. Normally, very little fluid is present in this space. An accumulation of excess fluid between the layers of the pleura is called a pleural effusion.
Alternative Names
Pleural fluid aspiration; Pleural tap
How the test is performed
A small area of skin on your chest or back is washed with a sterilizing solution. Some numbing medicine (local anesthetic) is injected in this area. A needle is then placed through the skin of the chest wall into the space around the lungs called the pleural space. Fluid is withdrawn and collected and may be sent to a laboratory for analysis (pleural fluid analysis).
How to prepare for the test
No special preparation is needed before the procedure. A chest x-ray is may be performed before and after the test.
Do not cough, breathe deeply, or move during the test to avoid injury to the lung.
How the test will feel
You will on a bed or sit on the edge of a chair or bed with your head and arms resting on a table. The skin around the procedure site is disinfected and the area is draped. A local anesthetic is injected into the skin. The thoracentesis needle is inserted above the rib into the pleural space.
There will be a stinging sensation when the local anesthetic is injected, and you may feel a sensation of pressure when the needle is inserted into the pleural space.
Inform your health care provider if you develop shortness of breath or chest pain.
Why the test is performed
The test is performed to determine the cause of the fluid accumulation or to relieve the symptoms associated with the fluid accumulation.
Normal Values
Normally the pleural cavity contains only a very small amount of fluid.
What abnormal results mean
The analysis of the fluid will indicate possible causes of pleural effusion such as infection, cancer, heart failure, cirrhosis, and kidney disease. If infection is suspected, a culture of the fluid is often done to determine whether microorganisms are present and if so, to identify them.
Additional conditions under which the test may be performed include the following:
Pneumonia
Hemothorax
Pulmonary veno-occlusive disease
Pancreatitis
Pulmonary embolism
Thyroid disease
Collagen vascular disease
Asbestos-related pleural effusion
Drug reactions
What the risks are
Pneumothorax (collapse of the lung)
Fluid re-accumulation
Pulmonary edema
Bleeding
Infection
Respiratory distress
Special considerations
A chest x-ray is often done after the procedure to detect possible complications.
THE WHITE HAND SIGN, A NEW SIMPLE MANEUVER USEFUL IN THE DIAGNOSIS OF THORACIC OUTLET SYNDROME
Southern Medical Association. 96th Annual Scientific Assembly - Washington, November 13-16, 2002
A simple objective test to assess the positional vascular obstruction at the thoracic outlet is the observation of the change of colors of the hands when the patient elevates the hands above the shoulder girdle, with the fingers pointed to the ceiling and the palms facing the observer. The appearance of the paleness, sometimes cadaveric, in one or both hands is called the White Hand Sign.
Thoracic Outlet Syndrome is a group of symptoms arising not only from the upper extremity, but also from the chest, neck, shoulders and head. The symptoms are produced by a positional intermittent compression of the brachial plexus and/or subclavian artery, vein and the vertebral artery; the diagnosis is readily suspected by the physician who is aware of the symptoms. The White Hand Sign will objectively assess the postural vascular compression at the thoracic outlet. The absence of the color changes on the elevation of the hands should not be construed that Thoracic Outlet Syndrome is not present, severe nerve compression can exist without vascular compression.
The use in the physical examination of a triad consisting of tenderness of the supraclavicular area, paleness and/or paresthesias on elevation of the hands, and weakness of the abductors and adductors of the 5th finger, will make the diagnosis of Thoracic Outlet Syndrome consistent and reproducible.
A new physical sign called the White Hand Sign is described. When used with the diagnostic triad in the routine physical examination, it will standardize the diagnosis of Thoracic Outlet Syndrome.
