Thoracentesis (also called pleurocentesis) is a medical procedure performed on mesothelioma patients who have a pleural effusion, a condition where a significant amount of excess fluid builds up in the space between the lungs and chest wall (the pleural space). This palliative therapy, meaning it’s used to address painful symptoms as opposed to an attempt to cure disease, is more likely to be used in patients with advanced mesothelioma in order to drain this fluid buildup, as it is a less aggressive option than a pleurodesis.
Normally, when breathing, the body produces a small amount of fluid to lubricate the lungs and prevent friction as the lungs move up and down (or in and out). Mesothelioma causes abnormal changes in the tissues, often leading to excess production of this fluid. This results in lung compression that can make it difficult to breathe comfortably, or take deep breaths.
Thoracentesis is also performed as a diagnostic procedure, in which a small amount of fluid is removed and sent to a pathology lab for analysis. Examination of the pleural fluid can help doctors determine the cause of fluid buildup. In addition to mesothelioma, pleural effusion can also be a sign of other conditions, including lung infections, kidney and liver disease, and congestive heart failure. Thoracentesis is not used as a sole diagnostic test for mesothelioma, however, which usually requires a tissue biopsy.
The Thoracentesis Procedure
Thoracentesis uses a special hollow needle that is very carefully inserted into the pleural space so excess fluid can be gently extracted to reduce pressure on the lungs. It’s not a cure or treatment for the disease itself, but rather a treatment to ease symptoms and improve quality of life.
The procedure can be performed in a doctor’s office, a medical center or a hospital. Before beginning the procedure, a numbing anesthetic will be injected into the chest wall where the larger hollow needle will be inserted. Once the area is numb, the hollow needle will be guided into the pleural space using an imaging technique like ultrasound, CT scanning or a special “real-time” X-ray to make sure the needle tip is accurately placed.
Patients may feel pressure in the chest as the needle moves into the pleural space. After the placement of the needle is confirmed, the fluid will be carefully drawn out. The procedure takes less than a half hour. Once complete, the needle location will be covered with a small bandage. Thoracentesis is usually followed by a chest X-ray to verify the amount of fluid removed and to check for complications such as air accumulation in the chest cavity.
Palliative Benefits
Most patients experience an improvement in breathing right after the procedure is complete and the excess fluid has been removed. There may be some soreness at the incision site which will resolve soon afterward. Overall benefits include:
- Improved breathing
- Reduced chest and lung pressure
- Lessened pain
- Increased space for lung expansion
Risks and Complications
Thoracentesis is generally a safe procedure, and it can offer significant benefits to many mesothelioma patients. Still, when considering whether or not to have the procedure, there are a few potential risks to be aware of, including:
- Complete or partial collapse of the lung, which can occur if the lung is accidentally punctured by the needle during treatment.
- Excess fluid in the lungs, a condition called pulmonary edema, which occurs most commonly if too much fluid is removed from the pleural space.
- Rarely, damage to the liver or spleen if the needle is not properly placed.
As with most surgeries, infection and bleeding are also risks. An X-ray of your chest may be taken afterward to ensure no complications are present.
Is Thoracentesis Right for You?
Thoracentesis is a relatively safe and painless procedure that removes the fluid buildup of a pleural effusion. Although thoracentesis does not treat or cure mesothelioma, it can be very helpful for diagnosing the underlying cause of the effusion and for dealing with patients’ symptoms. However, not every mesothelioma patient is a candidate for thoracentesis. Talk to your doctor to determine whether or not this procedure will be helpful for you.
Sources:
1. Thoracentesis. WebMD.
2. Brauner, Mark E. Thoracentesis. Medscape.
3. Thoracentesis. Johns Hopkins Medicine Health Library.
4. Thoracentesis. American Thoracic Society.
5. https://www.maacenter.org/treatment/surgery/thoracentesis/
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