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Two cases of transient asymptomatic hydrothorax during pregnancy are reported. In both cases the effusions resolved completely within a week of the termination of pregnancy. No apparent pathologic explanation could be found for this finding.
We describe the case of a 36 old woman with a right massive hydrothorax resulting from Controlled Ovarian Hyperstimulation (COH) for infertility. This complication is defined as Ovarian Hyperstimulation Syndrome (OHSS) which usually includes abdominal pain, nausea and ascites, rarely involving the respiratory apparatus. The usual determining factors of OHSS are the presence of high serum estradiol levels and pregnancy. In the case that we describe the serum estradiol levels during COH were monitored and were slightly higher than the COH alarm threshold and the patient was not pregnant.
We reported a successful pleuro-venous shunt operation (Pl-V shunt) for a patient of liver cirrhosis with secondary hydrothorax. A 78-year-old female was admitted to our hospital because of severe dyspnea and palpitation. Chest x-ray film revealed right sided massive pleural effusion. Over several weeks the chest tube drainaged about 1,500 ml of transudative fluid per day. We performed Pl-V shunting and pleural effusion subsequently decreased in amount and dyspnea disappeared. This Pl-V shunting is thought to be useful for such a patient with massive pleural effusion which failed to respond to medical therapy.
Hepatic hydrothorax is a complication of hepatic cirrhosis which frequently conditions respiratory insufficiency. Traditional therapy is almost always inefficacious. The paper reports four cases which were successfully treated using pleurodesis with sterile talc. Treatment was simple with no major complications. At the 6-month check-up no cases of recurrent pleural effusion were observed.
A central venous catheter was inserted into the right internal jugular vein of a 67-year-old woman to provide parenteral nutrition on the 7th day after surgery. Five days later, mediastinitis with bilateral hydrothorax had developed and was causing respiratory failure and systemic inflammatory response syndrome secondary to documented vascular perforation by the catheter. Four factors have been associated with increased risk of perforation: catheter rigidity and diameter, the angle between the tip of the catheter and the vessel wall, and insertion from the left. Three catheter positions have been described as safe when radiologically confirmed: the superior vena cava, the point where the superior vena cava meets the atrium, and the midpoint of the innominate vein. However, it should not be forgotten that a radiograph is 2-dimensional and a single image of a catheter tip can correspond to a variety of locations (superior vena cava, vena innominata, extravascular location, and more). Even when there is clinical and radiologic evidence of catheter positioning, vascular perforation should be suspected in patients with a central venous catheter and bilateral pleural effusion who present respiratory insufficiency and hemodynamic instability.
Acute hydrothorax is a well-recognized complication of continuous ambulatory peritoneal dialysis and is often regarded as a contraindication to its use. We report three cases treated by surgical closure of a communication between the peritoneal and pleural cavities enabling CAPD to continue successfully. This is a simple, safe and effective procedure which merits wider use as an alternative to transferring the patient to permanent hemodialysis.
Ovarian hyperstimulation syndrome (OHSS) is an unusual complication of ovarian stimulation with exogenous gonadotrophins. We describe a case of severe OHSS with bilateral hydrothorax and ascites. We discuss the different pathogenetic hypothesis and the differential diagnostic possibility.
A case of hepatic hydrothorax without clinical ascites is reported. The diagnosis was confirmed by intraperitoneal injection of 99mTc-tin colloid: scintigraphic images taken between 5 min and 18 h p.i. demonstrated a one-way transdiaphragmatic flow into the pleural cavity. The therapy consisted of diuretic treatment, pleural drainage and chemical pleurodesis, and resulted in prompt clinical improvement.
We report a case of hydrothorax after cannulation of left internal jugular vein that was not detected early. This complication could be due to various factors: first, venous approach from the left side, given its special anatomic arrangement; second, cardiorespiratory dynamics, and head and neck motion on postural changes during the intervention, and third, incorrect fixation of the catheter to the skin. We discuss preventive measures to avoid such complication. Finally, we advise right approach wherever possible as well as routine control of correct placement of the catheter tip by radiographic film with contrast medium.
We report a case of possible detouring and malfunctioning of the left subclavian catheter in the homolateral internal mammary vein or of perforation form its tip of the wall of the left innominate vein. The tip of the catheter was rigid and sharp, may be the contractions of the heart or turbulent flow impinged it against the vein wall and have enhanced the perforation. The result was a hydrothorax that allowed a severe cardiac simile tamponed syndrome. The pathophysiology was also discussed.
A rare case of combined bilateral hydrothorax and hydromediastinum was encountered during Total Parenteral Nutrition (TPN) via incannulation of the left internal jugular vein in a patient with advanced cancer of the portio. The possible anatomical and technical causes of this very serious complication were investigated in order to assess the importance of specific manual technique and to supply appropriate instrumental back-up that could prevent the recurrence of this sometimes fatal complication of TPN.
Two patients with alcoholic cirrhosis of the liver with ascites were evaluated for the pathogenesis of right sided massive pleural effusion. The clinical course of events suggested a large communication between the peritoneal space and right pleural cavity. Real time ultrasonography revealed evidence of a tear in the right hemidiaphragm. The role of ultrasound in the documentation of cause of hydrothorax in chronic liver disease is highlighted.
The thoracic duct and right lymphatic duct of the dogs in the experimental group were ligated at the neck. Saline labelled with Evans blue was injected (10 ml.kg-1) into the pleural cavity. The colloid osmotic pressure of the saline was adjusted to be exactly equal to that of normal pleural liquid. The change in the volume of the liquid and the decrease of the marker were studied for 3 h. The dynamics of the pleural liquid were investigated. In the control group, the volume of the pleural liquid decreased at the rate of 1.31 ml.h-1.kg-1 body weight and 87% of it left via the lymphatics. With the ligation of the bilateral lymphatic ducts, the lymphatic removal rate decreased to about one tenth. This result shows that the hydrothorax leaves the pleural cavity mainly via the lymphatics.
Unusual antenatal treatment of a case of severe fetal hydrothorax with secondary polyhydramnios and preterm labor is presented and illustrated. Bilateral pleural drainage catheters were placed antenatally to decompress the fetal chest in an effort to prolong pregnancy because of immature pulmonary studies and poor prognosis. Catheter migration occurred and effective drainage ceased after three days, but with tocolysis and bilateral thoracentesis, delivery was delayed another 48 hours to allow steroid therapy. With ventilatory therapy and chest drainage the infant survived and is doing well at one year of age.
It is reported on a female patient who during the intermittent peritoneal dialysis treatment acutely acquired a hydrothorax. The conservative course of treatment is described-a restitution was achieved. The patient is continued to be treated routinely in the IPD programme.
Two patients with known chronic ascites developed new massive right-sided pleural effusions. Chest tube placement led to massive protein and electrolyte depletion and death of both patients. Patients who have cirrhosis and massive right-sided pleural effusions, in general, have congenital diaphragmatic defects that predispose them to life-threatening fluid depletion when chest tubes are inserted. Hepatic hydrothorax is a relative contraindication to chest tube insertion.
Bilateral hydrothorax of the newborn is not compatible with life. It must, therefore, be diagnosed sonographically before birth and drained immediately following birth. The therapy which can be applied is discussed with reference to a case.
The congenital hydrothorax is a rare cause of the RDS in the newborn. Our observations on three patients with bilateral pleural effusions and 44 cases from the literature will be discussed; we emphasize the importance of this serious disease in the newborn period. The pathogenesis is largely unknown, however, its possible etiology like birth trauma or dysplasia of the lymphatic system are discussed. It should be pointed out that this condition can be rapidly recognized by radiographic examination and successfully treated. The reported survival rate is 29 out of 44 (66%).