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Although very experienced operators performing unguided aspirations have been shown to achieve similarly low complication rates to those seen with the use of US guidance,32,33 it has also been demonstrated that unguided aspiration results in incorrect needle placement in 15% of cases regardless of operator experience.34 The majority of pleural aspirations are performed by less experienced operators and the current consensus is that all pleural aspirations should be carried out after US confirmation of the size and position of pleural fluid. US guidance has been shown [http://www.selleckchem.com/products/Neratinib(HKI-272).html selleck] to reduce both the failure rate and complication rate of pleural aspirations.35�C37 Thoracic US is particularly useful following a failed [http://en.wikipedia.org/wiki/RVX_208 RVX-208] blind pleural aspiration. Pneumothorax.? Complication rates for pleural aspiration are generally lower than those associated with percutaneous needle biopsy as only one layer of pleura is transgressed. Pneumothorax is the most common complication, with a retrospective cohort study (n?=?342)35 finding a pneumothorax rate of 18% in the blind aspiration group compared with 3% in the US-guided group. Another retrospective cohort study (n?=?523)37 found a pneumothorax rate of 10.3% (with 4.9% requiring a chest drain) in the clinically localized procedure group compared with 4.9% (with 0.7% requiring a drain) in the US-guided group. Significantly higher pneumothorax rates have been demonstrated after aspiration with larger bore needles.35 [http://www.selleckchem.com/products/BMS-777607.html Selleck BMS777607] Aspiration of larger amounts of fluid has also been shown to result in an increased likelihood of pneumothorax. Josephson et?al.38 found that draining between 1.8 and 2.2?L was associated with a threefold increase in the frequency of post-procedure pneumothoraces when compared with draining 0.8�C1.2?L, and that draining more than 2.3?L was associated with nearly a sixfold increase. It is common practice in many radiology departments to perform US to select an appropriate site for later drainage on the ward following skin marking even though some studies have not shown any difference in complication rates when compared with clinical localization only.35,36 Small or loculated effusions should be aspirated under direct US guidance. Monitoring of the development and subsequent management of pneumothorax and other complications is similar to lung needle biopsy. Routine CXR after an uncomplicated, US-guided diagnostic tap is not mandatory. Care should be taken during thoracocentesis to minimize the introduction of air by occluding the cannula to the atmosphere at all times except when the patient is in the expiratory phase of respiration. Haemothorax.? Significant haemorrhage as a result of thoracocentesis is unlikely. A directly subcostal approach should be avoided. US does not appear to reduce the incidence of laceration of the intercostal vessels as these are not generally seen on scanning.