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The skin of your chest is washed with antiseptic and
a very fine needle is used to administer local anaesthetic. The local anaesthetic stings for a few
A small cut is made in the skin and a needle or thin plastic tube is inserted into the space between your
lung and chest wall to remove the fluid. The doctor
may use an ultrasound to see the inside of your
Dr Stuart Lyon, Ms Ann Revell, Prof Grant Russell,
chest on a screen, as this can help find where the
Most frequently, this area is at the back of your
What is a pleural aspiration?
chest or to the side. This is the reason why the
A pleural aspiration is a procedure where a small
doctor stands behind you while doing the pleural
needle or tube is inserted into the space between
aspiration. You may be asked to hold your breath by
the lung and chest wall to remove fluid that has
the doctor who is carrying out the procedure.
accumulated around the lung. This space is called
Depending on the amount of fluid removed, a tube
may be left in place whilst the fluid drains out.
Pleural aspiration is usually carried out to determine
After the procedure, the small opening in the skin is
why there is fluid around the lung (diagnostic
procedure) or to improve symptoms (therapeutic
procedure), as the fluid around the lung may be
A chest X-ray is usually carried out 2–4 hours after
causing symptoms such as cough, shortness of
the procedure to assess for any complications.
Complications are uncommon and are outlined in the
‘What are the risks of a pleural aspiration?’ section.
How do I prepare for a pleural aspiration?
Do not eat or drink for 4 hours before the
Are there any after effects of a pleural
procedure. This is a routine precaution for many
medical procedures. If you are diabetic, you should
The area where the needle or tube has been
inserted may feel a little tender for several days and
You may need to stop medications that thin your
there may be some bruising. If the area is painful,
blood, as this may unnecessarily increase your risk
simple pain relievers, such as paracetamol
of bleeding. Examples include warfarin (often sold as
Coumadin or Jantoven), clopidogrel (often sold as
Your skin usually heals in a few days and you may
Plavix), asasantin, heparin and enoxaparin sodium
have a tiny scar (typically less than 5 mm) at the
(often sold as Clexane). If you take any of these
site where the needle or tube was inserted.
medications or have any concerns about whether or
not to stop taking them, please discuss this with
How long does a pleural aspiration take?
your radiology practice before the procedure.
The time taken for a pleural aspiration varies
Bring all of your usual medication(s) (or a complete
depending on how much fluid needs to be removed.
list) with you when you attend for the procedure.
It may take less than an hour or several hours. A
Bring with you, if possible, relevant films or CDs
chest X-ray is usually carried out 2–4 hours after the
containing your previous imaging. This includes X-
procedure and you will require medical supervision
rays, ultrasounds, computed tomography (CT) scans
until this occurs. This X-ray is carried out to check
or magnetic resonance imaging (MRI). It is common
for what is called a pneumothorax. A pneumothorax
(but not essential) for people needing pleural
is a leak of air into the space around the lung (see
aspiration to have had a chest X-ray, chest
What are the risks of a pleural aspiration?
Make arrangements with a relative or friend to drive
There are some risks of a pleural aspiration that you should know about. Most of the more serious ones
(pneumothorax, major bleeding from a large artery
What happens during a pleural
or vein in the chest, or fluid accumulation in the
lung) occur at the time of or very soon after the
A pleural aspiration is carried out whilst you are
procedure. This means they will be recognised while
sitting upright on the side of a bed and leaning
you are being observed in hospital or at the imaging
forward. You will usually be provided with a place to
rest your arms so you can lean over comfortably.
A Quality Use of Diagnostic Imaging (QUDI) Initiative
Immediate risks of the procedure include:
Where is a pleural aspiration done?
Air around the lung (pneumothorax) and
A pleural aspiration is usually carried out in a
collapse of the lung
: When carrying out the
hospital or large medical centre, as you will require
procedure, air may enter the space around the lung
monitoring throughout the procedure in a setting
via the drainage tube. Air may also leak from the
where medical staff will be available to treat you in
lung tissue itself. This is called a pneumothorax and
can occur in up to 30% of cases. If this is a small leak you do not need treatment. If it is a bigger one
When can I expect the results of my
you may need a chest tube and to stay in hospital.
Fluid build up in the lung
: It is possible for fluid
If you are having fluid removed to relieve your
to collect in your lung and make you short of breath,
shortness of breath, you can expect significant relief
particularly if a large amount of fluid is removed and
your lung re-expands very quickly. This is an
uncommon problem, but you may need to stay in
If fluid is sent to a pathologist for further analysis,
the time that it takes your doctor to receive a written report will vary depending on:
Injury to your liver, spleen or heart
: There is a
small risk of injury to your liver, spleen or heart.
• the urgency with which the result is needed
This is a very rare complication, particularly if an
• how the report is conveyed from the practice or
ultrasound is used to assist with the procedure, but
hospital to your doctor (in other words, email,
After you are allowed to leave, seek medical
Please feel free to ask the staff where you are
attention urgently immediately if you notice any of
having your procedure when your doctor is likely to
the following, as they may suggest a serious
complication that requires immediate treatment:
It is important that you discuss the results with the
• A lot of bleeding from the small cut in your skin.
doctor who referred you, either in person or on the
telephone, so that they can explain what the results
Increasing shortness of breath. This may include
leakage of air around the lung that needs
Further information about pleural
New or worsening pain whilst breathing deeply.
The results of a pleural aspiration are sometimes inconclusive. If this occurs, the aspiration may need
: There is a small risk of infection. If
to be repeated or alternative tests may be required.
infection does occur, it is usually very minor and can be treated with antibiotics.
What are the benefits of having a pleural
A sample of the fluid that has been removed can be
This information is of a general nature only and is
sent to a pathologist (a specialist doctor trained in
not intended as a substitute for medical advice. It is
analysing fluid) to determine why it has
designed to support, not replace, the relationship
that exists between a patient and his/her doctor. It
is recommended that any specific questions
A pleural aspiration can make you feel more
regarding your procedure be discussed with your
comfortable, as the fluid around your lung may be
causing symptoms including shortness of breath, cough or chest pain.
The InsideRadiology website is managed by the
Who does the pleural aspiration?
RANZCR and funded by the Australian Government
Many different types of doctors carry out pleural
Department of Health and Ageing under the
aspirations. It is commonly carried out by
December 31st 2010
guidance is used, surgeons, physicians and general practitioners.
The RANZCR is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might
be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
The RANZCR intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for
medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
The RANZCR recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, The RANZCR, its officers, councillors and employees assume no responsibility for its
content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.
A Quality Use of Diagnostic Imaging (QUDI) Initiative
Patients’ decisions to die: The emerging Australian jurisprudence A series of decisions by McDougall J in Hunter and New England Area Health Service vA (2009) 74 NSWLR 88; Martin CJ in Brightwater Care Group (Inc) v Rossiter (2009) 40WAR 84; Higgins CJ in Australian Capital Territory v JT (2009) 232 FLR 322; andKourakis J in H Ltd v J (2010) 240 FLR 402 has built upon prior decisions
A N N A L S O F T H E N E W Y O R K A C A D E M Y O F S C I E N C E SIssue: Cooley’s Anemia: Ninth Symposium Treatment options for thalassemia patients with osteoporosis Evangelos Terpos1 and Ersi Voskaridou21Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece. 2Thalassemia Center, LaikonGeneral Hospital, Athens, GreeceAddress for correspondence: Evan