The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased
pneumothorax and avoid
chest tube placement in cases of
pneumothorax following interventional radiological procedures performed under computed tomography fluoroscopic guidance with the transthoracic percutaneous approach. While still on the scanner table, 102 cases underwent percutaneous manual aspiration of a moderate or large
pneumothorax that had developed during mediastinal, lung, and transthoracic liver biopsies and ablations of lung and hepatic
tumors (independent of symptoms). Air was aspirated from the pleural space by an 18- or 20-gauge intravenous
catheter attached to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. In 87 of the 102 patients (85.3%), the
pneumothorax had resolved completely on follow-up chest radiographs without
chest tube placement, but
chest tube placement was required in 15 patients. Requirement of
chest tube insertion significantly increased in parallel with the increased volume of aspirated air. When receiver-operating characteristic curves were applied retrospectively, the optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to
chest tube placement was 670 mL. Percutaneous manual aspiration of the
pneumothorax performed immediately after the procedure might prevent progressive
pneumothorax and eliminate the need for
chest tube placement. However, when the amount of aspirated air is large (such as more than 670 mL),
chest tube placement should be considered.