Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Large volume thoracentesis

John T Huggins, MD
Amit Chopra, MD
Section Editor
V Courtney Broaddus, MD
Deputy Editor
Geraldine Finlay, MD


Large volume thoracentesis refers to the removal of more than one liter of pleural fluid during a therapeutic thoracentesis. Large volume thoracentesis is performed to relieve dyspnea associated with a pleural effusion. Assessment of the initial pleural fluid pressure and the changes in pressure as fluid is removed (known as the pleural space elastance) can be used to guide fluid removal.

The technique for large volume thoracentesis will be reviewed here. The diagnostic evaluation of pleural fluid and the techniques for pleural manometry and diagnostic thoracentesis are discussed separately. (See "Measurement of pleural pressure" and "Diagnostic thoracentesis" and "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology".)


Large volume thoracentesis refers to removal of more than 1 L of pleural fluid during a therapeutic thoracentesis.

Pleural elastance is the change in pleural pressure with removal of a given volume of pleural fluid. It is calculated by dividing the change in pleural pressure by the volume removed. A normal pleural elastance is estimated to be <14.5 cm H2O/L [1]. (See "Measurement of pleural pressure", section on 'Pleural elastance'.)

The initial pleural pressure of a free-flowing pleural effusion with an expandable lung is typically slightly positive (pleural pressure in the absence of fluid is slightly negative) and changes minimally as fluid is withdrawn. (See "Measurement of pleural pressure", section on 'Interpretation of pleural pressures'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 18, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Heidecker J, Huggins JT, Sahn SA, Doelken P. Pathophysiology of pneumothorax following ultrasound-guided thoracentesis. Chest 2006; 130:1173.
  2. Daniels CE, Ryu JH. Improving the safety of thoracentesis. Curr Opin Pulm Med 2011; 17:232.
  3. Havelock T, Teoh R, Laws D, et al. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 Suppl 2:ii61.
  4. Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment. Chest 2009; 135:1315.
  5. Huggins JT, Doelken P. Pleural manometry. Clin Chest Med 2006; 27:229.
  6. Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med 2010; 170:332.
  7. Doelken P, Huggins JT, Pastis NJ, Sahn SA. Pleural manometry: technique and clinical implications. Chest 2004; 126:1764.
  8. Light RW, Jenkinson SG, Minh VD, George RB. Observations on pleural fluid pressures as fluid is withdrawn during thoracentesis. Am Rev Respir Dis 1980; 121:799.
  9. Feller-Kopman D. Therapeutic thoracentesis: the role of ultrasound and pleural manometry. Curr Opin Pulm Med 2007; 13:312.
  10. Feller-Kopman D, Walkey A, Berkowitz D, Ernst A. The relationship of pleural pressure to symptom development during therapeutic thoracentesis. Chest 2006; 129:1556.
  11. Light RW, Stansbury DW, Brown SE. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. Am Rev Respir Dis 1986; 133:658.
  12. Mynarek G, Brabrand K, Jakobsen JA, Kolbenstvedt A. Complications following ultrasound-guided thoracocentesis. Acta Radiol 2004; 45:519.
  13. Jones PW, Moyers JP, Rogers JT, et al. Ultrasound-guided thoracentesis: is it a safer method? Chest 2003; 123:418.
  14. Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg 2007; 84:1656.
  15. Lin YJ, Yu YH. Reexpansion pulmonary edema after large-volume thoracentesis. Ann Thorac Surg 2011; 92:1550.
  16. Tarver RD, Broderick LS, Conces DJ Jr. Reexpansion pulmonary edema. J Thorac Imaging 1996; 11:198.
  17. Josephson T, Nordenskjold CA, Larsson J, et al. Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax. Acta Radiol 2009; 50:42.
  18. Woodring JH, Baker MD, Stark P. Pneumothorax ex vacuo. Chest 1996; 110:1102.