Thoracentesis

Thoracentesis is a specific medical procedure performed to remove excess fluid around the lungs. The fluid collects in the small space called the pleural space (between the lung and the inner surface of the chest wall). When too much collects there, it often affects how freely the lungs move with each breath. The procedure is not done casually; it’s usually considered when scans confirm the presence of fluid and symptoms suggest it needs to come out. The primary purpose is relief and to get a sample for testing. It is carried out under supervision, step by step, in a clinical setting.

During thoracentesis, a doctor inserts a needle or a thin tube through the chest wall to reach the pleural space and drain the trapped fluid. The amount removed varies depending on the amount present and the patient's management during the procedure. The fluid is collected and sent for laboratory analysis to check for causes such as infection, inflammation, tuberculosis, cancer, or fluid retention due to heart, liver, or kidney conditions.

Ultrasound is commonly used beforehand to choose a safe point of entry. Ultrasound guidance is used to select the safest entry point, helping the doctor avoid essential structures. The fluid is removed slowly so the lung can adjust as space is created again. The patient is closely monitored throughout, and if breathing changes or discomfort appears, the team responds right away. The purpose is to ease pressure on the lungs and to learn what caused the fluid, so further treatment can be planned with a clearer understanding.

Fluid can collect around the lungs for different reasons, and this is known as a pleural effusion. It does not continually develop at the same pace; sometimes it takes weeks, and other times it becomes obvious sooner. 

• Pneumonia or tuberculosis can be possible causes.

• Heart conditions can cause fluid to accumulate if the body retains more fluid than it should.
• Liver or kidney problems may lead to fluid buildup that eventually reaches the chest area. Inflammation in the lining around the lungs can produce excess fluid on its own.
• Certain cancers can cause the fluid to return repeatedly or increase over time.

• Fluid may also develop after a chest operation or due to an injury in the area, especially if healing takes time or inflammation develops.

Symptoms of Pleural Effusion

People usually start to feel that something is off with their breathing rather than notice a single clear symptom. For example:

• Breathing may feel heavier than usual, as if the lungs are not moving as freely.

• Climbing stairs or lying flat might cause breathlessness sooner than expected.
• Some describe it as not getting a full breath, like the lung is not expanding all the way.
• A dry cough may persist even after someone has already used the standard treatments. There may be a pressure-like feeling in the chest, which becomes noticeable with movement.

• Turning to one side or taking a deeper breath might feel uncomfortable or restricted.

These signs do not diagnose the cause on their own, but they are an apparent reason to seek medical evaluation and to understand why the fluid is present.

Doctors may suggest thoracentesis when there is:

• Difficulty breathing due to fluid around the lungs

• Chest pressure or heaviness that persists
• A pleural effusion is identified on imaging
• Concern about infection, including tuberculosis or pneumonia-related fluid

• Suspicion of cancer-related effusion that needs testing

Additional points:

• It helps identify the cause as well as provide relief

• Even partial drainage may improve breathing

In advanced cases, it can still reduce discomfort and help with daily activities

A patient may be suitable when:

• Scans confirm fluid that can be safely reached

• Breathing is affected by the build-up
• The patient is stable enough for the procedure

• Testing of the fluid is required for diagnosis

Thoracentesis may be delayed if the amount of fluid is too small to access safely, if bleeding disorders are not controlled, or if the patient is medically unstable and needs stabilisation first.

Before the Procedure

• Imaging is reviewed to understand the location of the fluid

• Blood tests may be done to check the safety of the procedure

• Medicines, especially blood thinners, are discussed

Patients are guided about positioning and breathing during the procedure so they feel prepared rather than anxious.

During the Procedure

Thoracentesis is usually done with the patient sitting upright.

• The skin is cleaned and numbed with local anaesthesia

• A needle or catheter is inserted into the pleural space
• Fluid is removed slowly and collected for testing

• Breathing and comfort are monitored throughout

Ultrasound may be used to support accuracy and safety.

After the Procedure

Breathing usually feels lighter once some of the fluid has been taken out. Before leaving the procedure room, the puncture site is cleaned, covered, and checked. A chest X-ray may be performed to confirm that the lung has expanded properly and to rule out any immediate concerns.

Patients are kept under observation for a short period to ensure everything is settling well. Many people can go home the same day. In some situations, particularly when a larger volume of fluid has been removed or the patient needs closer observation, an overnight stay may be advised. A short admission allows the team to monitor breathing, check the lungs on imaging if needed, and make sure recovery is progressing without difficulty.

If the medical condition suggests the fluid may return, the doctor will discuss the next steps. The plan may include another drainage if needed or treatment to control how much fluid collects again. The approach depends on the underlying condition causing the effusion and the patient's overall response. At Gleneagles Hospitals, this process is carried out with exquisite care at every step: preparation before the procedure, supervision during drainage, and guidance after discharge so the person knows what to watch for and when to follow up.

Thoracentesis is generally considered safe when performed by trained clinical staff, but there are points patients should be aware of. Some tenderness may occur at the site where the needle was placed, and a brief cough may occur as the lung adjusts. Bleeding or infection is uncommon and is monitored for during recovery. In rare cases, the lung may take longer to expand fully; if this occurs, it is managed appropriately.

Clear discharge instructions and routine follow-up reduce most concerns and help patients move through the recovery period with greater confidence.

Thoracentesis can help a person breathe more comfortably by removing the excess fluid that is pressing on the lungs. The removed fluid is tested so the doctor can understand why it was collected and what treatment should follow. If the condition causes the fluid to return, the procedure can be repeated as needed.

At Gleneagles Hospitals, the procedure is handled by experienced clinicians who regularly manage pleural effusion and related breathing problems. The procedure is supported by advanced imaging, designated treatment areas, and monitoring systems to ensure patient safety. Ultrasound guidance is commonly used to select a safe point of entry, and the patient is monitored before and after the procedure. The aim is a clear plan, careful supervision, and practical guidance for recovery rather than a rushed experience.

Thoracentesis serves both diagnostic and treatment purposes. It can make breathing easier and provide essential information about the cause of a pleural effusion. After the doctor reviews the results, follow-up checks are done. Thoracentesis can help keep symptoms under control and guide the subsequent treatment.