SHM Converge Scientific Abstract ePoster Gallery-Skip the X-Ray, Use Pocus Post-Thoracentesis for Pneumothorax Surveillance

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This retrospective study asked whether post-thoracentesis lung point-of-care ultrasound (POCUS) could replace routine chest X-ray (CXR) for pneumothorax surveillance in a teaching hospital.<br /><br />Researchers reviewed thoracentesis cases performed by a medical procedural team from January 2020 to October 2024. Of 326 charts, 262 met inclusion criteria. The average patient age was 63.1 years, 54.2% were male, and many had major comorbidities such as heart failure, cirrhosis, and renal disease.<br /><br />Among the 262 patients, 21 (8%) developed a pneumothorax. Most were small and clinically insignificant; only one patient required chest-tube placement. Some radiographic pneumothoraces may have represented small amounts of air introduced during catheter removal rather than true complications. The average delay between the post-procedure lung ultrasound and CXR interpretation was 8 hours and 46 minutes.<br /><br />Lung POCUS showed very low sensitivity (4.8%) but very high specificity (99.1%). Positive predictive value was 33.3%, and negative predictive value was 91.8%. The low sensitivity was likely influenced by the small number of pneumothorax cases and limited confirmatory CT imaging. CT chest was used as the reference standard when ultrasound was abnormal but CXR was negative.<br /><br />The authors conclude that routine CXR after uncomplicated thoracentesis rarely changes management and often detects only clinically minor pneumothoraces. They argue that lung POCUS may be a useful primary surveillance tool to reduce unnecessary imaging, lower costs, improve workflow, and support resident training. Selective CXR use in symptomatic or high-risk patients may be a safer and more cost-effective strategy.

Asset Subtitle

Joanna Marie Hilao

Meta Tag

Author List Firas Abbas, Joanna Marie Hilao, Mariel Ma, Trevor Helton

Category Research

Concept Lung Point-of-Care Ultrasound

Concept Thoracentesis

Concept Plain Radiograph

Concept Pneumothorax

Concept Diagnostic Performance

Distinguished Non-Finalist

Presenter Organization University of Arizona College of Medicine - Phoenix

Presenting Author Joanna Marie Hilao

Track Quality Improvement

Keywords

thoracentesis

pneumothorax

lung POCUS

chest X-ray

post-procedure surveillance

retrospective study

ultrasound sensitivity

teaching hospital

pleural effusion

imaging cost reduction

Lung Point-of-Care Ultrasound

Thoracentesis

Plain Radiograph

Pneumothorax

Diagnostic Performance