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Iatrogenic Pneumothorax During Thoracentesis — SCE Palliative Medicine MCQ

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HardRespiratory SymptomsIatrogenic Pneumothorax During ThoracentesisSCE Palliative Medicine

During ultrasound-guided thoracentesis for malignant effusion, the patient suddenly coughs and reports ipsilateral pleuritic pain. Air is aspirated through the catheter and breath sounds diminish. What complication is most likely?

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Correct answer: C — An iatrogenic pneumothorax during pleural access

Abrupt pleuritic pain, reduced breath sounds and aspiration of air during pleural access indicate iatrogenic pneumothorax. Ultrasound reduces but does not abolish risk. Management depends on symptoms, size, ongoing air leak and underlying lung reserve. Re-expansion pulmonary oedema usually develops after large-volume drainage and presents with hypoxaemia and pulmonary infiltrates rather than air aspiration.

Reference: British Thoracic Society Clinical Statement on pleural procedures: https://www.brit-thoracic.org.uk/document-library/clinical-statements/pleural-procedures/pleural-procedures-full-supplement/