[Ovarian cyst with ascites and hydrothorax (Demons-Meigs syndrome)].
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Female↗
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Meigs' syndrome--an incomplete form with severe hydrothorax.
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Aged↗
[Pain of the right thoracic region and dysphagia (thoracic radiography and hydrothorax): (pleural mesothelioma)].
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Humans↗
[Subcutaneous emphysema in perforated gastric or duodenal ulcer. A case with hydrothorax].
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Aged↗
Hepatic hydrothorax without diaphragmatic defect. An original surgical treatment.
A 58-year-old woman with a long history of well-compensated postnecrotic cirrhosis with acute massive ascites and right-sided pleural effusion was admitted. The injection of colorant and radioactive material into the peritoneal cavity didn't show up any passage through the diaphragm. After resuscitation therapy and insertion of abdominal and chest tube, effusions rapidly and massively re-accumulated. A LeVeen peritoneovenous shunt was inserted as an emergency measure owing to hepatorenal syndrome. Ascites completely resolved but pleural effosion was continuously and severely recharged. A Denver inverted shunt was subcutaneously inserted from pleural to peritoneal cavity. After operation CPAP was applied and pump device activated; pleural effusion gradually disappeared clearing completely the pleural space. The patient was discharged on the 10th postoperative day; her general condition and laboratory test have remained satisfactory up to one year without ascites and pleural effusion.
Ascites↗
[Medical treatment of chylous effusions in newborn infants. Apropos of 3 cases].
BACKGROUND: Chylous effusions are the most frequent cause of non immunologic hydrops fetalis. They can be recognized antenatally by ultrasonography. Their evacuation is sometimes necessary and medical treatment often effective. CASE REPORTS: Case n. 1: fetal ascites was detected by ultrasonography at the 30th week of gestation. Paracentesis was performed at 36 weeks, followed 3 days later by spontaneous delivery. The newborn was fed milk formula. A second paracentesis showed a milky fluid, rich in cholesterol, triglycerides and chylomicrons. The child was fed formula rich in medium-chain triglycerides and the chylous ascites disappeared completely within 2 weeks. Case n. 2: a diagnosis of bilateral hydrothorax and hydramnios was made at the 27th week of gestation. An in utero evacuation of the hydrothorax performed at the 30th week was ineffective and a pleuro-amniotic drainage was performed 2 weeks later. The baby was born at the 35th week, and presented a moderate respiratory distress due to the hydrothorax and ascites. Aspiration of the thoracic fluid confirmed its chylous origin. The chylous effusions completely disappeared when the child was fed a high medium chain triglycerides diet. A lymphedema of legs appeared at the age of 1 month. Case n. 3: ascites, hydramnios, hydrothorax and peripheral edema were found at the 21st week of a third pregnancy (the 2 first pregnancies were complicated by lethal hydrops fetalis). Bilateral hydrothorax and peripheral edema were found again after birth at the 37th week. Diuresis and albumin-infusion led to recovery, but chylothorax and chylous ascites reaccumulated after introduction of milk formula, despite repeated evacuations and feeding medium-chain triglycerides formula. The thoracic fluid remains chylous at the age of 9 months. CONCLUSIONS: In utero, and sometimes post-natal, evacuation of fluid present in the thoracic and peritoneal cavities can be necessary, depending of the functional tolerance. Medical management including feeding a low fat and/or high medium-chain triglycerides diet, and sometimes temporary total parental nutrition, is necessary, together with salt restriction, diuresis and albumin infusion as required. Most cases recover spontaneously or as a result of therapy within a few weeks.
Chylothorax↗
Pseudo-Meigs' Syndrome.
Meigs' syndrome is defined as a hydrothorax with ascites and a pelvic tumor, both of which resolve on removal of the tumor. Pseudo-Meigs' is a variant not possessing the original tumor cell types described by Meigs. Both these syndromes should be considered in otherwise healthy women who present with either new or recurrent hydrothorax and ascites. This case concerns a 21-year-old woman who presented to the emergency department (ED) with a recurrent hydrothorax. After performing a pelvic examination that was suspicious for a pelvic mass, further evaluation by ultrasonography showed ascites and a pelvic tumor. Surgeons from the Obstetrics and Gynecology Department performed an exploratory laparotomy with removal of the tumor. Subsequently, there was no recurrence of the ascites and hydrothorax. The tumor was diagnosed histologically as a benign mature teratoma. The literature of Meigs' and Pseudo-Meigs' is reviewed, focusing on the history, pathology, and clinical characteristics. The clinical significance for the emergency physician is discussed.
Adult↗
[An atypical Demons-Meigs syndrome].
Meigs'syndrome is defined as a hydrothorax with ascites and benign ovarian tumor, both of which resolve on removal of the tumor. Pseudo-Meigs'syndrome or atypical Meigs'syndrome occurs when a pelvic mass other than an ovarian fibroma is present with hydrothorax and ascites. Both these syndromes should be nevertheless considered in women who present hydrothorax and ascites. This case concerns a 50-year-old woman who presented a pseudo-Meigs'syndrome (Hydrothorax and uterine leiomyoma). The distinction between these two syndrome is useless, because tumour removal is the only treatment.
Ascites↗
[Pleuroamniotic shunting--case report].
Fetal hydrothorax refers to a collection of fluid within the fetal thorax that may be the result of chylous leak from the thoracic duct (primary hydrothorax) or generalized fluid retention associated with immune or no immune fetal hydrops (secondary hydrothorax). The authors' presents a case report occurred in 2002, of a pregnant woman that at 25 weeks' gestation that was referred to Maternidade Bissaya-Barreto-Coimbra because of a fetal hydrothorax at left, under tension and with cardiac decompensation signs. A fetal thoracocentesis was performed and the diagnosis was chylothorax. Because of a rapid reaccumulation of fluid a pleuroamniotic shunt was placed. The effusion and the cardiac decompensation signs regressed. The delivery was at 38 weeks' gestation. The newborn had been stable. Actually he has 10 months, is healthy and has a normal grow and development.
Amnion↗
Mechanism and implications of brown adipose tissue proliferation in rats and monkeys treated with the thiazolidinedione darglitazone, a potent peroxisome proliferator-activated receptor-gamma agonist.
Thiazolidinediones represent an established class of insulin sensitizing agents for treating noninsulin-dependent diabetes mellitus. Darglitazone, a thiazolidinedione approximately 200x more potent than ciglitazone, was evaluated in preclinical safety assessment studies using rats (1, 5, and 50 mg/kg/day) and cynomolgus monkeys (50, 75, and 100 mg/kg/day). Darglitazone was a potent adipogenic agent in rats, causing hyperplastic/hypertrophic changes and firmness of white and perirenal, dorsal thoracic (TBAT), and interscapular brown adipose tissue (BAT). Progressive changes in BAT size, morphology, firmness, and fatty acid composition preceded clinical signs of impaired respiration and the subsequent development of a dose-dependent, life-threatening hydrothorax. The characteristics of the pleural effusate were consistent with lymphatic fluid. These adverse effects were ameliorated/reversed upon drug withdrawal and were insulin-dependent since rats rendered totally insulinopenic by streptozotocin pretreatment did not develop TBAT changes or hydrothorax. Although the effects of darglitazone on BAT changes were consistent with enhanced sensitivity to endogenous glucocorticoids, adrenalectomy, and dietary dehydroepiandrosterone administration were without a protective effect. Treated monkeys also developed white and BAT hyperplasia/hypertrophy, peripheral edema, and hydrothorax-related morbidity/mortality. Both species developed reversible, dose-related reductions in red blood cell parameters and follicular atresia. Peripheral and pulmonary edema are purportedly a multifactorial process involving vasodilatation, increased endothelial permeability, and/or plasma volume expansion due to reduced renal sodium excretion. Moreover, profound alterations in TBAT hypertrophy/hyperplasia/firmness may lead to discrete hydrothorax by restricting normal thoracic lymphatic drainage. Similar effects on adipose tissue, hemodilution, and edema (peripheral and pulmonary) were observed clinically with darglitazone and/or several other structurally similar/dissimilar PPAR-gamma agonists.
Adipose Tissue, Brown↗
Tension hemothorax following abdominal surgery - a rare presentation of congenital diaphragmatic defect.
BACKGROUND: Small congenital diaphragmatic defects are usually occult, but can present as a problem in patients with increased abdominal fluid as unilateral massive hydrothorax. We present a unique case presentation of a small congenital diaphragmatic defect. CASE REPORT: A 79 female immediately postoperatively developed a hydrothorax following low anterior resection for rectal cancer. The hydrothorax turned out to be due to an intrabdominal bleed in a patient with a previously undiagnosed congenital diaphragmatic hernia. The respiratory ball value mechanism worked as a pump to move blood from the abdomen to the chest and caused a tension hemothorax. RESULTS: Surgeons should be aware that a post operative hydrothorax could be associated with an intrabdominal complication of recent surgery. CONCLUSIONS: A small occult congenital diaphragmatic defect and associated ball value mechanism may provide an unexpected but clinically significant communication between the abdominal and thoracic cavities.
Abdomen↗
Spontaneous bacterial empyema in cirrhotic patients: a prospective study.
Spontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in cirrhotic patients and has seldom been reported. To determine its incidence and primary characteristics, all cirrhotic patients with pleural effusion underwent thoracentesis at our hospital either on admission or when an infection was suspected. Pleural fluid (PF) study included biochemical analysis, polymorphonuclear (PMN) leukocyte count, and culture by two methods: conventional and modified (inoculation of 10 mL of PF into a blood culture bottle at the bedside). SBEM was defined according to previously reported criteria: PF culture positive or PMN count greater than 500 cells/micro L, and exclusion of parapneumonic effusions. Sixteen of the 120 (13 percent) cirrhotic patients admitted with hydrothorax had 24 episodes of SBEM. In 10 of the 24 episodes (43 percent), SBEM was not associated with spontaneous bacterial peritonitis (SBP). PF culture was positive by the conventional method in 8 episodes (33 percent) and by the modified method (blood culture inoculation) in 18 (75 percent) (P = .004, McNemar). The microorganisms identified in PF were Escherichia coli in 8 episodes, Streptococcus species in 4, Enterococcus species in 3, Klebsiella pneumoniae in 2, and Pseudomonas stutzeri in 1. All episodes were treated with antibiotics without inserting a chest tube in any case. Mortality during treatment was 20 percent. We conclude that SBEM is a common complication of cirrhotic patients with hydrothorax. Almost half of the episodes were not associated with SBP; thus, thoracentesis should be performed in patients with cirrhosis, pleural effusion, and suspected infection. Culture of PF should be performed by inoculating 10 mL into a blood culture bottle at the bedside.
Bacterial Infections↗
Struma ovarii associated with pseudo-Meigs' syndrome and elevated serum CA 125.
BACKGROUND: Struma ovarii, presenting as pseudo-Meigs' syndrome with an elevated CA 125 level, is a rare condition. CASE: A 65-year-old patient presented with ascites, hydrothorax, right ovarian mass, and elevated CA 125 level. These findings were suspicious for an ovarian malignancy. The mass was removed and revealed struma ovarii, a specialized ovarian teratoma composed predominantly of mature thyroid tissue. In the setting of ascites and hydrothorax, the condition is known as pseudo-Meigs' syndrome. This is the second reported case in the English language literature of pseudo-Meigs' syndrome with an elevated CA 125 level resulting from struma ovarii. CONCLUSION: Struma ovarii is a rare cause of ascites, hydrothorax, and an elevated CA 125 level.
Aged↗
Video-assisted talc pleurodesis in the management of pleural effusion secondary to continuous ambulatory peritoneal dialysis: a report of three cases.
Continuous ambulatory peritoneal dialysis (CAPD) is an effective treatment for end-stage renal disease. Hydrothorax secondary to pleuroperitoneal communication is an unusual complication of CAPD, with persistence or recurrence requiring alternate forms of dialysis. We have recently managed three patients with CAPD-induced right hydrothorax secondary to such communications. Earlier treatment methods have included thoracentesis or tube thoracostomy with chemical pleurodesis and even thoracotomy with attempts to locate and close the communication. We used a new approach consisting of video-assisted thoracic surgery and direct talc poudrage. All patients were successfully returned to CAPD; one patient required a repeat procedure after an initial recurrence. Video-assisted thoracic surgery with talc poudrage is an effective and safe procedure with minimal morbidity for management of hydrothorax secondary to CAPD. This procedure allows identification of diaphragmatic defects amenable to repair and talc placement under direct visualization, allowing even distribution over the inferior surface of the lung.
Aged↗
Removal of pleural liquid and protein by lymphatics in awake sheep.
The contribution of the parietal pleural lymphatics to pleural liquid and protein removal is unclear. We asked two questions. What is the rate of removal of sterile, artificial hydrothoraxes in awake sheep? What percentage is removed through parietal pleural lymphatics? Three days after the placement of a rib capsule in 18 sheep, we instilled a 10 ml/kg 1.0 g/dl autologous protein solution with labeled albumin and erythrocytes through the capsule into the pleural space. Erythrocytes were used as a marker for lymphatic flow. We measured terminal pleural liquid volume and radioactivity at periods from 2 to 48 h. In three sheep, we obtained a third volume measurement at 6 h by the volume of dilution technique. We found that hydrothorax removal could be described by a linear function with a constant rate: 0.28 +/- 0.01 ml.kg-1.h-1 (mean +/- SE) for the grouped data, and 0.20, 0.28, and 0.31 ml.kg-1.h-1 for the individual sheep. At 24 h, erythrocyte clearance was 89 +/- 16% (mean +/- SD) that of liquid and albumin clearance. We conclude that in awake sheep with large hydrothoraxes, pleural liquid and protein are removed at a rate of 0.28 +/- 0.01 ml.kg-1.h-1 (mean +/- SE) and lymphatics are responsible for at least 89% of this removal.
Animals↗
[Videoscopic surgical treatment for the patient of pleuroperitoneal communication complicating CAPD].
A 60-year-old female presented in end-stage renal failure. She was introduced continuous ambulatory peritoneal dialysis in August 1997. After about six months, acute hydrothorax developed in her right side of the pleural cavity. Then she was obligated to give up CAPD because of repeated recurrence of hydrothorax. She wanted to return to CAPD for her life style. In November 1998, she came to our hospital to have a surgical treatment for her pleuroperitoneal communication. We performed video assisted thoracoscopic surgery. Using methylene blue containing dialysis solution through CAPD catheter, we found a bleb on the diaphragm that expanded gradually. We diagnosed that potion was pleuroperitoneal communication. The defect of diaphragm was directly closed with surgical stapler. Post-operative course was very favorable. She could restarted CAPD at 3 postoperative day, and discharged from our hospital after 5 days of operation. No recurrence of hydrothorax has been detected for a years after the surgical treatment.
Female↗
[Thoracoscopic repair of diaphragmatic thinning for pleuroperitoneal communication; report of a case].
A 53-year-old man presented with massive right hydrothorax just after introduction of continuous ambulatory peritoneal dialysis (CAPD). Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we diagnosed pleuroperitoneal communication. Thoracoscopic surgery was performed and thinning of the diaphragm was found. We sutured the diaphragm to repair the thin portion and performed pleurodesis with 50% glucose solution. He restarted CAPD 1 month post-operatively and continued at home without pleural effusion. Eight months post-operatively, he experienced dyspnea again and chest X-ray showed right hydrothorax. Although the cause of recurrent hydrothorax is unknown, it may be that not only surgical repair but also more intense pleurodesis is needed.
Diaphragm↗
[Non septic, surgical complications and their treatment of acute necrotizing pancreatitis in 131 cases].
The authors analyse non septic, surgical complications and their treatment in 131 patients with acute necrotizing pancreatitis. Bleeding occurred in 13 patients 16 times. There were 3 cases with large intestine perforation, small intestine perforation twice in one patient and hydrothorax in 12 patients. The patients APACHE-II score was in the range of 15, 5, which was quite high. They experienced complications such as bleeding and bowel perforations mostly in those who underwent several reoperations. For the bleeding from acute duodenal ulcer conservative and surgical therapy (suturing) was executed. In the cases of intraabdominal bleeding they used several options such as, ligature, collagen mesh, Surgicell net and tamponation. Large intestine perforations were surgically treated with Hartmann's procedure or loop colostomy. The small intestine perforation was simply sutured. From the 12 patients with hydrothorax 8 underwent thoracic drainage. We lost 7 patients with bleeding, 3 with bowel perforations and 2 with hydrothorax. The authors believe that complications during therapy of acute necrotizing pancreatitis are high risk factor, but their treatment is not hopeless.
APACHE↗