[Treatment of refractory hydrothorax in liver cirrhosis by pleuro-peritoneal shunting].
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Isolated bilateral pleural effusion with mediastinal compression leading to hydropic change of the fetus is unusual, and carries a high risk of perinatal death. This condition can be reversed in utero by performing ultrasound-guided shunting surgery. We describe a hydropic fetus at 30 weeks' gestation with rapid recurrence of pleural effusion after thoracentesis. The pleural effusion and hydrops resolved within 1 week after ultrasound-guided thoracoamniotic shunt and the fetal lungs were restored to their normal size. The fetus was born at 35 weeks' gestation and had an uneventful postnatal course. The technique of restoring cardiopulmonary function in utero through intrathoracic decompression offers a valuable alternative to repetitive prenatal thoracentesis or preterm delivery of fetuses with hydrops caused by bilateral pleural effusion.
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Massive pleural effusion occurring during continuous peritoneal dialysis (PD) is a rare, life-endangering complication of this procedure. We describe a case of a patient with type 2 diabetic end-stage renal disease (ESRD) treated by PD who had new-onset dyspnea, right pleural effusion, and uncontrolled hyperglycemia. Respiratory distress and pleural effusion progressed quickly during the course of dialysis. A large volume of a "sweet" fluid with a high glucose content was evacuated from the pleural space. Immediate improvement in the patient's condition and glucose control followed discontinuation of PD and initiation of hemodialysis.
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Percutaneous supracostal renal puncture provides ideal access to the collecting system or proximal ureter but is associated with an increased risk of pleural injury. We describe a simplified approach to intraoperative thoracostomy tube placement that uses urologic techniques and protects against recurrent hydrothoraces at second-look nephroscopy, without increasing patient morbidity or length of hospital stay.
The case of a 56-year-old man with a massive unilateral rightsided pleural effusion is described. The origin of the pleural effusion is a decompensated liver cirrhosis without ascites. The pathogenetic mechanisms and treatment are discussed.
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