From the Guidelines
Trapped lung after thoracentesis is a condition where the lung cannot fully re-expand to fill the pleural space after fluid is removed from around the lung, often due to a fibrous peel or thickened pleura formed around the lung, restricting its normal expansion. This condition typically develops when pleural effusion has been present for an extended period, allowing fibrous tissue to develop [ 1 ]. During thoracentesis, as fluid is withdrawn, patients may experience chest pain and a sensation of pulling, and clinicians may notice increased resistance when aspirating fluid. Diagnosis is confirmed when pleural pressure becomes increasingly negative during fluid removal, and imaging shows persistent pleural space despite fluid drainage.
Key Characteristics and Diagnosis
- The condition is characterized by the inability of the lung to fully expand after thoracentesis
- It is often associated with a fibrous peel or thickened pleura
- Diagnosis can be suspected based on clinical presentation and confirmed with imaging and pleural pressure measurements
- An initial pleural fluid pressure of < 10 cm H2O at thoracentesis makes trapped lung likely [ 1 ]
Management and Treatment
- Management focuses on treating the underlying cause of the effusion
- Options may include indwelling pleural catheters for symptomatic patients [ 1 ]
- In severe cases, surgical decortication to remove the restrictive fibrous tissue may be considered
- Pleuroperitoneal shunting is an alternative and effective option in patients with a trapped lung or failed pleurodesis [ 1 ]
Important Considerations
- Trapped lung does not require chest tube placement since the lung cannot expand further
- The condition may resolve spontaneously if the underlying inflammation subsides, allowing the pleural surfaces to heal
- It is essential to evaluate the patient's symptoms, general health, and functional status when considering treatment options [ 1 ]
From the Research
Definition of Trapped Lung
A trapped lung is a condition that can occur after a thoracentesis procedure, where the lung is unable to re-expand fully after the removal of fluid from the pleural space.
Causes of Trapped Lung
The causes of trapped lung are not explicitly stated in the provided studies, but it can be inferred that it may be related to the development of pneumothorax or re-expansion pulmonary edema after thoracentesis 2, 3, 4.
Risk Factors for Trapped Lung
The risk factors for trapped lung are not directly mentioned in the studies, but the following factors may contribute to its development:
- Pneumothorax, which can occur as a complication of thoracentesis 4
- Re-expansion pulmonary edema, which can occur after the removal of a large amount of fluid from the pleural space 2, 3
- The use of certain thoracentesis techniques, such as gravity drainage, which may have a higher complication rate compared to other methods 5
Prevention and Management of Trapped Lung
The prevention and management of trapped lung are not explicitly discussed in the provided studies, but the following strategies may be helpful:
- The use of ultrasound guidance during thoracentesis to reduce the risk of pneumothorax 3, 4
- The monitoring of pleural pressure during thoracentesis to prevent excessively negative pleural pressure 2
- The use of symptom-limited thoracentesis to avoid removing too much fluid at once 5
- The careful selection of patients for thoracentesis, taking into account their individual risk factors for complications 6