Pleural Tap (Thoracentesis) in Lucknow

The lung sits inside a thin double lining called the pleura. Between the two layers is a narrow space. When fluid collects there it is called a pleural effusion. The fluid presses on the lung, so you may feel breathless, cough, or have a tight or aching chest.

Common causes include heart failure, infections such as pneumonia and tuberculosis, liver or kidney disease and cancer. A pleural tap, or thoracentesis, passes a needle through the chest wall into the space to remove fluid. It can be done for testing, for relief or for both.

Ultrasound shows how much fluid there is, how deep it lies and where the lung, diaphragm, liver and spleen are. The radiologist marks a safe spot on your back or side, and may watch the needle as it enters. Guidance lowers the chance of puncturing the lung, compared with tapping by feel alone.

The scan also shows whether the fluid is free or divided into pockets. Pocketed fluid is harder to drain, and your doctor may need another approach.

A test sample is small. A tap for relief takes more fluid. Doctors limit how much is removed at one sitting, because taking too much too fast can cause coughing, chest tightness and, rarely, fluid in the lung. The team stops if you cough a lot or feel unwell.

Many people breathe more easily as the fluid drains, but not all breathlessness comes from fluid, and relief can be partial. The tap does not treat the cause. If the fluid returns, your doctor may advise treating the cause or draining it a different way.

The tests depend on your doctor's question. Common ones are:

• Protein and other chemistry, to tell the type of fluid.
• Cell count and culture, to look for infection.
• Cytology, where a pathologist looks for abnormal cells.
• Tests for tuberculosis, where it is suspected.

The report goes to the doctor who referred you. The team will tell you when to expect it. Blood tests that go with the fluid tests can be done at our pathology lab.

Serious problems after a pleural tap are uncommon. The main risks are:

• Pneumothorax: air enters the space and part of the lung collapses. This is the main risk. A small air leak often settles on its own, but a larger one needs a tube. Say at once if you become more breathless.
• Bleeding in the chest wall, usually small.
• Infection at the needle site or in the fluid.
• Faintness or a fall in blood pressure, and a cough as the lung expands.
• Pain at the site, or at the tip of the shoulder.

Doctors take extra care if you take blood thinners or have low platelets or a clotting problem. The team checks your reports before the day.

A chest X-ray may be advised afterwards. It is more likely if you are breathless or coughing, if air was drawn back into the syringe, or if a large amount of fluid was drained. It checks for a collapsed lung and shows how much fluid remains. A routine chest X-ray uses a small dose of radiation, so tell the staff if there is any chance you are pregnant.

Not everyone needs one. After an uncomplicated ultrasound-guided tap in a person with no symptoms, doctors may decide to skip it. Your doctor or the team decides.