Lymphatic obstruction: a possible explanation for left-sided pleural effusions associated with splenic hematomas

Leung, Fkl; Williams, A J; Guze, Phyllis A.

doi:10.2214/ajr.138.1.182-a

Cited by 1 publication

(4 citation statements)

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“…Exudative pleural effusion in atraumatic splenic rupture and splenomegaly could be explained by possible direct compression of posterior lymphatics by an enlarged spleen/hematoma or increased subphrenic permeability due to sympathetic activation associated with splenic trauma leading to accumulation of perisplenic fluid into the pleural cavity [4]. The timing of pleural effusion post-splenic trauma is almost immediate in all case reports [2][3][4]11]. Our patient presented with pleural effusion a month after spontaneous splenic rupture.…”

Section: Discussionmentioning

confidence: 67%

“…Koehler and Jones described the first three cases of left-sided pleural effusion in patients with splenic hematoma in the 1980s [2]. In a retrospective study by Kulaylat et al,4.1% of pediatric splenic trauma patients developed left-sided pleural effusion [3]. The incidence was higher with high-grade splenic injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Lower left rib fractures and left lung atelectasis in patients with splenic trauma might be significant contributing factors to the development of pleural effusion in these patients [3]. Exudative pleural effusion in atraumatic splenic rupture and splenomegaly could be explained by possible direct compression of posterior lymphatics by an enlarged spleen/hematoma or increased subphrenic permeability due to sympathetic activation associated with splenic trauma leading to accumulation of perisplenic fluid into the pleural cavity [4]. The timing of pleural effusion post-splenic trauma is almost immediate in all case reports [2][3][4]11].…”

Section: Discussionmentioning

confidence: 99%

“…The most common causes of unilateral left-sided pleural effusion include infection, malignancy, hepatic hydrothorax, or portal hypertension, especially in the context of cirrhosis and splenomegaly [1]. Recurrent unilateral pleural effusion due to splenic rupture is rare and has only been described to present simultaneously [2][3][4]. Moreover, guidelines on managing recurrent pleural effusion post-splenic rupture are lacking, and the treatment mainly depends on patient and physician preference.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Resolution of Recurrent Pleural Effusion in Atraumatic Splenic Rupture

Gupta¹,

Thameem²

2023

Cureus

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Spontaneous splenic rupture is an uncommon cause of acute-onset left-sided pleural effusion. It is often immediate with a high preponderance for recurrence, sometimes even requiring splenectomy. We report a case of spontaneous resolution of recurrent pleural effusion presenting a month after the initial atraumatic splenic rupture. Our patient was a 25-year-old male without significant medical history who was taking Emtricitabine/Tenofovir for pre-exposure prophylaxis. He presented to the pulmonology clinic for left-sided pleural effusion, diagnosed in the emergency department a day prior. He had a history of spontaneous grade III splenic injury one month before, where he was diagnosed with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) co-infection on polymerase chain reaction (PCR) testing and was managed conservatively. The patient underwent thoracentesis in the clinic, which showed exudative lymphocyte predominant pleural effusion and no malignant cells. The remainder of the infective workup was negative. He was readmitted two days later with worsening chest pain, and imaging revealed re-accumulation of pleural fluid. The patient declined thoracentesis, and a chest X-ray was repeated a week later, showing worsening pleural effusion. The patient insisted on continuing conservative management, and he was seen a week later with a repeat chest X-ray that showed near resolution of pleural effusion. Splenomegaly and splenic rupture can lead to pleural effusion due to posterior lymphatic obstruction, which can be recurrent. There are no current guidelines on management, and treatment options include watchful monitoring, splenectomy, or partial splenic embolization.

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