87 year old male in hospital getting better with fluid build up. latest chest x-ray showing - improved aeration of left lung base. small left plural effusion. now does a thoracentesis necessary for this? lung doc says may be not. but hospital prefers?

As I answered previously, if the etiology of the pleural effusion is not clear, thoracentesis may be indicated. I do not have enough information to make the diagnosis. However, if this patient has congestive heart failure or pneumonia and he's improved with treatment (either with diuresis or antibiotic therapy) and the left pleural effusion is small, there is no need for thoracentesis.

Different views. In general hospitals are not getting paid by insurances for early readmissions and their approach is now to treat proactively any possibility that patients will decompensate fast, once discharged. The lung doc does not feel a thoracentesis is absolutely needed for diagnostic and/or treatment purposes at this time.