Routine Postprocedure Chest Radiography Is Not Warranted After Right-Heart Catheterization

To determine whether routine postprocedure chest radiography is indicated to exclude pneumothorax after outpatient right heart catheterization with or without endomyocardial biopsy.

This HIPAA-compliant retrospective quality improvement cohort study was approved by the institutional review board. All outpatients from January 1, 2010, to July 1, 2017, who underwent routine postprocedure chest radiography after right heart catheterization with or without endomyocardial biopsy formed the study population (n = 6,036). Subjects were identified by electronic medical record query using Current Procedural Terminology codes. Pneumothorax prevalence was calculated by coded review of chest radiography reports. Size of pneumothorax (if present) and clinical outcome were determined, and 95% confidence intervals (CIs) were calculated.

Most (99%) right heart catheterizations were performed using an internal jugular vein approach, as determined by a random sample of 100 subjects. The prevalence of pneumothorax on postprocedure chest radiography reports was 0.1% (7 of 6,036; 95% CI: 0.05%-0.24%). Three of these seven pneumothoraces were confirmed by repeat imaging within 1 hour to be false-positives (ie, no pneumothorax), resulting in a corrected pneumothorax rate of 0.07% (4 of 6,036; 95% CI: 0.00%-0.2%). The remaining four that reported pneumothoraces were less than 1 cm. No chest tubes were placed, and all subjects were discharged home without an unexpected escalation in the level of care.

In a large cohort of over 6,000 subjects, pneumothorax after right heart catheterization utilizing an internal jugular vein approach was rare and when found was clinically insignificant. False-positives were common. Routine postprocedure chest radiography in this setting is not warranted and is being discontinued at the study institution.