Choice of pleural puncture site: Prospective comparative study between clinical exam and ultrasound

In thoracocentesis, the clinician usually relies on his clinical examination and chest x-ray to choose the appropriate site. This can be easy and safe for abundant pleural effusion . For pleural effusions of low to medium abundance ultrasound tracking is necessary. Aims: To Compare the accuracy of the diagnostic pleural puncture site between the clinical location and the ultrasound location in the patient9s bed. Methods: We carried out a prospective comparative study including 29 patients hospitalised for exploration of a pleural effusion based on the chest radiography. First, each patient had a double-blind clinical detection (based on the clinical examination and the chest X-ray) by an experienced doctor and a an intern. In a second step, and without changing the patient9s position, this site was checked by a doctor trained in thoracic ultrasound. our study included 29 patients (58 ± 18 y). A pleuritic syndrome was found in 95% of the cases. The abundance of effusion based on the radiography was estimated to be low to medium in 68% cases.Ultrasound did not confirm the presence of effusion in 4 patients (13%) rather revealing atelectasis (n=2) and pachypleuritis (n=2). The clinical identification proposed by the expert verified on ultrasound was precise and adequate in 69% of cases, versus 31% of an inadequate and dangerous site (liver, diaphragm or lung), especially in low abundance pleurisy.For interns, a pleural puncture site error was detected in 51% of the cases (liver, spleen, diaphragm or lung). Ultrasound tracking corrected the site chosen by clinical tracking in more than 50% of cases in both groups.