When is a pleural puncture performed?
The main indications are hydrothorax and pleurisy with accumulation of fluid causing shortness of breath, as well as pneumothorax. The puncture solves two problems at once: it relieves compression of the lung, which makes breathing easier almost immediately, and provides material for analysis. Examination of the fluid - for protein, cellular composition, microflora and atypical cells - often becomes decisive in making a diagnosis. The procedure is performed while sitting, along the upper edge of the rib (so as not to touch the intercostal neurovascular bundle), under ultrasound control. Afterwards, a control photograph is taken.
Why is liquid removed?
The accumulation of fluid in the pleural or abdominal cavity has two sides. Firstly, it mechanically compresses the lung or abdominal organs, causing shortness of breath, heaviness and disruption of organ function - its evacuation brings immediate relief.
Secondly, the liquid itself is the most important diagnostic material. Its analysis determines the nature of the process: inflammation, tumor, heart failure, cirrhosis of the liver. Often it is the puncture examination that makes the final diagnosis.
Puncture or drainage
Puncture is a one-time removal of fluid with a needle. It is suitable for small volumes and for diagnostic purposes. Drainage is the installation of a tube that remains in the cavity for several days and ensures constant outflow. It is chosen for large volumes, purulent contents and rapid re-accumulation of fluid.
Safety of the procedure
The modern standard is to perform a puncture under ultrasound guidance: the doctor sees the exact location of the fluid, lung and diaphragm. This significantly reduces the risk of pneumothorax and organ damage compared to blind puncture. A limited volume is evacuated at once to avoid a sharp shift of the mediastinum and a drop in pressure.