Massive Pleural Effusion as the Presenting Feature of a Subarachnoid-Pleural Fistula

Dsouza, Ryan J; Doshi, Amita; Bhojraj, Shekhar Y; Shetty, Prashant G.; Udwadia, Zarir

doi:10.1159/000049379

Cited by 32 publications

(30 citation statements)

References 11 publications

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“…50 A low pH 51 and a low glucose level 52 have been reported; these are important characteristics, as it is the only transudate in which these parameters are found to be low, with the exception of acidosis and hypoglycemia, respectively. [54][55][56] Once the fistula is created, the cerebrospinal fluid flows from the subarachnoid space into the pleural space along a pressure gradient. 52 Increased levels of LDH may occur, which would erroneously classify the fluid as an exudate.…”

Section: Urinothoraxmentioning

confidence: 99%

The Art of Pleural Fluid Analysis

Sahn

Huggins

José³

et al. 2013

Clinical Pulmonary Medicine

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Although a pleural effusion (PE) is a common condition in clinical practice (with a prevalence of slightly > 400 patients/100,000), a definitive diagnosis is not established in approximately 20% of cases. In the classic publications, thoracentesis provided a definitive or presumptive diagnosis in 73% of cases, although it is estimated that today this percentage could reach 95%. An undiagnosed PE is defined as one that remains of unknown origin after performing complete pleural fluid analysis (nucleated cell counts with differential diagnosis, biochemistry, culture, cytology, and flow cytometry). The aim of this paper is to review the difficulties that may be encountered when attempting to establish the cause of a PE. The reason for this diagnostic dilemma may be an atypical clinical or radiologic presentation or falsepositive or false-negative results. Furthermore, the limited frequency of some PEs is often not considered when determining the differential diagnosis.

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Section: Urinothoraxmentioning

confidence: 99%

The Art of Pleural Fluid Analysis

Sahn

Huggins

José³

et al. 2013

Clinical Pulmonary Medicine

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“…While laminectomy is a common neurosurgical procedure to treat injuries related to the spine, there are only two reports of the complication of DPF [1, 2]. Most cases of DPF are secondary to blunt and penetrating trauma with a total of 23 reports since 1959.…”

Section: Commentsmentioning

confidence: 99%

“…Some advocate chest tube drainage for up to 2 weeks before a decision to operate. Of the two nontraumatic DPF cases, one patient had spontaneous resolution via chest tube drainage, and the other underwent successful surgical repair [1, 2]. Although there are anecdotal reports of spontaneous closure following chest tube placement, in theory, chest tube drainage would maintain a persistent pressure gradient and impede closure of the fistula.…”

Section: Commentsmentioning

confidence: 99%

Duro-Pleural Fistula Diagnosed by β<sub>2</sub>-Transferrin

Huggins

Sahn²

2003

Respiration

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An 81-year-old man was referred for evaluation of a chronic transudative pleural effusion that required 8 therapeutic thoracenteses over 11 months for relief of dyspnea. Extensive lumbar disk surgery had been performed 2 years prior to his onset of dyspnea. The diagnosis of duro-pleural fistula was confirmed by finding the presence of β₂-transferrin in the pleural fluid. The ‘water-like’ pleural fluid had a total protein of <1 gm/dl, an LDH of 92 IU/l, a glucose of 101 mg/dl, and pH of 7.55. β₂-Transferrin has a sensitivity approaching 100% and a specificity of 95% in identifying CSF leaks from head trauma. To our knowledge, this is the first report of β₂-transferrin in pleural fluid from a duro-pleural fistula.

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“…[25][26][27][28][29][30][31] Various surgical endeavours have been described to combat the continuation of these fistulae which can result in respiratory embarrassment, meningeal pseudocysts, arachnoiditis and low pressure symptomatology. 30 Omental plugging, 30 the use of positive-pressure ventilation 29 and lumboperitoneal shunting 32 have all been described.…”

Section: Discussionmentioning

confidence: 99%