Depth of pleural effusion in thoracentesis: Comparison of lateral, posterolateral and posterior approaches in the supine position

Jeong Min Ko, Jisoon Kim, Soo An Park, Kwang Nam Jin, Myeong Im Ahn, Seok Chan Kim, Dae Hee Han

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. Objectives: To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. Materials and Methods: First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-tolarge effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. Results: In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the midaxillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P< 0.001). In thirteen effusions (40.6%), DPE was greater than 1cmin both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%). Conclusion: Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

Original languageEnglish (US)
Article numbere20919
JournalIranian Journal of Radiology
Volume13
Issue number2
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Supine Position
Pleural Effusion
Pulmonary Atelectasis
Cadaver
Safety
Thoracentesis
Water

Keywords

  • Posterior approach
  • Posterolateral approach
  • Supine thoracentesis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Depth of pleural effusion in thoracentesis : Comparison of lateral, posterolateral and posterior approaches in the supine position. / Ko, Jeong Min; Kim, Jisoon; Park, Soo An; Jin, Kwang Nam; Ahn, Myeong Im; Kim, Seok Chan; Han, Dae Hee.

In: Iranian Journal of Radiology, Vol. 13, No. 2, e20919, 01.04.2016.

Research output: Contribution to journalArticle

Ko, Jeong Min ; Kim, Jisoon ; Park, Soo An ; Jin, Kwang Nam ; Ahn, Myeong Im ; Kim, Seok Chan ; Han, Dae Hee. / Depth of pleural effusion in thoracentesis : Comparison of lateral, posterolateral and posterior approaches in the supine position. In: Iranian Journal of Radiology. 2016 ; Vol. 13, No. 2.
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abstract = "Background: In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. Objectives: To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. Materials and Methods: First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-tolarge effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. Results: In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the midaxillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P< 0.001). In thirteen effusions (40.6{\%}), DPE was greater than 1cmin both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3{\%} and 90.6{\%}) were higher (P < 0.001) than that in the lateral route (28.1{\%}). Conclusion: Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.",
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T1 - Depth of pleural effusion in thoracentesis

T2 - Comparison of lateral, posterolateral and posterior approaches in the supine position

AU - Ko, Jeong Min

AU - Kim, Jisoon

AU - Park, Soo An

AU - Jin, Kwang Nam

AU - Ahn, Myeong Im

AU - Kim, Seok Chan

AU - Han, Dae Hee

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background: In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. Objectives: To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. Materials and Methods: First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-tolarge effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. Results: In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the midaxillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P< 0.001). In thirteen effusions (40.6%), DPE was greater than 1cmin both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%). Conclusion: Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

AB - Background: In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. Objectives: To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. Materials and Methods: First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-tolarge effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. Results: In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the midaxillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P< 0.001). In thirteen effusions (40.6%), DPE was greater than 1cmin both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%). Conclusion: Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

KW - Posterior approach

KW - Posterolateral approach

KW - Supine thoracentesis

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