Predictive Role of Lung Ultrasound in Re-Expansion Pulmonary Edema During Thoracocentesis

This study evaluates the feasibility, safety, and predictive role of dynamic bedside Lung Ultrasound (LUS) during therapeutic thoracocentesis in patients with moderate-to-massive pleural effusions. Re-expansion pulmonary edema (RPE) is a rare but potentially life-threatening complication of rapid pleural fluid drainage. In this single-arm pilot study, participants undergo therapeutic thoracocentesis guided by serial LUS assessments performed at predefined drainage volume milestones (T0: baseline, T1: 500 mL, T2: 1000 mL, T\_3: 1500 mL, and T End). Rather than relying solely on predetermined total drainage limits, procedure modification or early termination is dynamically guided by real-time ultrasound findings (such as coalescent B-lines and subpleural consolidations) alongside clinical monitoring. The main goal is to assess whether serial LUS monitoring can reliably detect early sonographic features of evolving pulmonary edema and inform clinical decision-making during pleural fluid removal.

Inclusion Criteria: 1. Adults aged \>= 18 years. 2. Moderate-to-massive pleural effusion confirmed by clinical and radiological assessment. 3. Clinical indication for therapeutic thoracocentesis. 4. Ability to provide written informed consent. Exclusion Criteria: 1. Active congestive heart failure with established or suspected cardiogenic pulmonary edema. 2. Hydropneumothorax or active chest-tube drainage before enrollment. 3. Severe uncorrected coagulopathy or clinically significant bleeding diathesis precluding thoracocentesis. 4. Baseline hemodynamic instability requiring vasopressor support. 5. Requirement for invasive or non-invasive mechanical ventilatory support before the procedure. 6. Pregnancy. 7. Inability to cooperate with the procedure or refusal to participate.