A pleural puncture is the puncture of the pleural space between the ribs and the lungs. A distinction is made between diagnostic and therapeutic pleural puncture. The diagnostic puncture is used to obtain material.
The material obtained can then be used for diagnostics, for example to determine pathogens or to detect tuberculosis. It thus helps to determine the cause of effusion formation. For example, bacteria can be an indication of an inflammation and certain cells can indicate a malignoma.
During therapeutic puncture, larger quantities of the effusion are removed when it becomes symptomatic and leads to shortness of breath, in order to achieve better lung ventilation. A clear separation between therapeutic and diagnostic puncture is only made in a part of the punctures, as most therapeutic punctures are also used for diagnostic purposes. An exception are known or recurrent effusions in case of known malignancy or in case of cardiac decompensation.
A pleural effusion can consist of various fluids. If the effusion is blood, it is called hematothorax; if it is pus, it is called pulmonary empyema. If there is a massive accumulation of effusion, the life-threatening mediastinal shift can occur, in which the work of the heart is hindered and the flow of blood in the large blood vessels can be impeded.
A pleural puncture should be performed if the accumulation of fluid in the pleural gap causes the displacement of lung tissue. The lung can then be pushed to the opposite side, making breathing more difficult. Fluid accumulation in the pleural gap can occur in diseases such as heart muscle weakness and protein deficiency in the blood, both due to malnutrition and certain kidney diseases.
Other causes can be lung cancer, purulent inflammation of the lungs or bruising, which can occur after rib fractures, accidents or falls with bruising. In these cases, therapeutic punctures are performed to relieve the pressure on the lung tissue. Less frequently, punctures are performed solely for diagnostic reasons.
A diagnostic puncture should be performed to find the cause of fluid accumulation. This can be used to determine whether bacteria, viruses or fungi are responsible for the effusion accumulation. Therapeutic puncture should be performed when effusions become clinically symptomatic due to shortness of breath or pain. This can be the case especially with malignant effusions.