Authors' reply.

Sir,

We would like to thank our readers for showing interest in our article[1] and expressing their views on this topic. The authors had raised some doubts over therapeutic pleural fluid aspiration especially in asymptomatic patients and we too had mentioned in our discussion that there is still no consensus on this. We had discussed in our article that all the patients included in the study had moderate to massive tuberculous pleural effusion and experienced dyspnea at rest or on exertion. Therefore, there was an indication for therapeutic thoracentesis in each of the patients.

The authors have rightly pointed out that we did not discuss about the development of pneumothorax following thoracentesis in our patients. This is because none of the 52 patients included in our study developed iatrogenic pneumothorax following either diagnostic or therapeutic thoracentesis. Apart from vasovagal reactions in a couple of patients, we did not encounter any other complications following thoracentesis. The most likely explanation may be, since this study was done in a tertiary level teaching hospital, all the interventional procedures were done by trained residents under the supervision of the faculties of Pulmonary Medicine. A prospective bivariate analytical study had suggested that thoracentesis-related pneumothorax is rare and is not easily predictable when the procedures are performed under faculty supervision in a controlled environment.[2] There are other studies also which claim that thoracentesis is a very safe procedure with few complications.[34]

A comparative analytical study to establish the risk-benefit ratio would have been useful if the procedures were associated with multiple complications like pneumothorax, vasovagal reactions, re-expansion pulmonary edema, hemothorax, or subcutaneous hematoma.