Showing papers on "Hydrothorax published in 1991"

Hepatic hydrothorax : cause and management

Abstract: Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. A large effusion (hepatic hydrothorax) occasionally appears during the course of the disease. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic cirrhosis. Although the exact mechanism is somewhat controversial, it appears that the ascitic fluid is transported directly into the pleural space. A therapeutic thoracentesis, usually accompanied by a paracentesis, may be necessary to relieve acute symptoms. Long-term management, however, centers around eliminating or reducing the formation of ascites. When this is not successful, tube thoracostomy followed by chemical pleurodesis, primary repair of diaphragmatic defects with pleural sclerosis, or peritoneovenous shunting in conjunction with chemical pleurodesis may be attempted. These interventions may or may not be successful. Management of hepatic hydrothorax remains a clinical challenge. ( Arch Intern Med. 1991;151:2383-2388)

Pulmonary sequestration: diagnosis with color Doppler sonography and a new theory of associated hydrothorax.

Abstract: The diagnosis of pulmonary sequestration has traditionally relied on angiographic demonstration of a systemic artery to the sequestered lung tissue. Rarely, extralobar sequestration can be associated with tension hydrothorax, which in the past has invariably led to fetal hydrops and death. The authors report the cases of three infants who had initially undergone color and spectral Doppler analysis; in two of them, extralobar sequestrations were associated with congenital hydrothorax. All three patients underwent surgical resection and histopathologic evaluation of their sequestrations. On the basis of the findings, the authors believe that torsion of the sequestration occludes the efferent venous and lymphatic channels, initiating the accumulation of pleural fluid and subsequent hydrops through systemic venous obstruction. Color Doppler made possible the identification of minute feeding vessels, obviating further diagnostic studies.

Cardiac Tamponade and Hydrothorax as Complications of Central Venous Parenteral Nutrition in Infants

Abstract: The recent use of soft catheters made of silastic polymeric silicone or polyurethane has decreased the incidence of perforation of great veins or right-sided heart chambers but has not eliminated it as had been hoped. Two premature infants who presented with cardiac tamponade more than 24 hr after the insertion of a 23-gauge silastic catheter for total parenteral nutrition (TPN) administration are described. In one infant, bilateral hydrothorax preceded the occurrence of cardiac tamponade. Osmotic injury to great vessels and/or myocardium seems to be the common mechanism but which these complications of intraluminal catheters are produced. Review of the pediatric literature revealed a proportion of low birth weight infants among the reported cases. Despite a prohibitively high mortality rate, early recognition can prevent a fatal outcome. (Journal of Parenteral and Enteral Nutrition 15:110-113,1991)

Surgical treatment of massive hydrothorax complicating continuous ambulatory peritoneal dialysis.

Abstract: 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.

Bilateral pleural and pericardial effusions because of mediastinal placement of a central venous catheter.

Abstract: Pneumothorax, hydrothorax, hydromediastinum, and cardiac tamponade are uncommon, although not unusual, complications of central venous catheter placement. We report a case of hydromediastinum with bilateral pleural and pericardial effusions, occurring in a patient after placement of a Silastic double-lumen central venous catheter for hyperalimentation. (Journal of Parenteral and Enteral Nutrition 15:676-679, 1991)

Diagnosis of hydrothorax-complicating CAPD and demonstration of successful therapy by scintigraphy.

Abstract: Sir: CAPD can be associated with diaphragmatic peri tonealleak, which is usually difficult to localize and hence to be corrected surgically. Peritoneal scintigraphy has been reported to be useful in the diagnosis of this complication (1,2). We report a patient in whom peritoneal scintigraphy was useful not only in the diagnosis ofpleuroperitoneal communication but also in the confirmation of the effectiveness of the surgical correction, allowing the resumption of CAPD after short interruption. The patient was an 81-year-old man with endstage renal disease secondary to chronic interstitial nephritis. He was on CAPD for 2 years. CAPD was considered the most appropriate treatment for this gypsy man who refused to stay in hospital. On admission, he had dyspnea; physical examination and chest x-ray revealed pleural effusion. Because of the possibility of a trans diaphragmatic leak, peritoneal scintigraphy was performed using a 370 MBq (10 mCi) dose of 99m Tc-albumin colloid instilled intraperitoneally through the dialysis cathe ter and flushed with the usual 2 L of dialysis solution. Scintigraphic views were obtained using a large field of view scintillation camera set at the 140 key photopeak with a 20% window and equipped with a lowenergy parallel hole collimator. Starting at the time of infusion, a dynamic series of 1 minute anterior views centered on the diaphragmatic region were obtained for 15 minutes; then static anterior, posterior and lateral views of the abdomen and thorax were obtained at 16, 20, 30 minutes, 1 and 6 hours. During the first 8 minutes of the study, a normal progressive diffuse pattern of activity was observed in projection of the abdominal cavity. At 9 minutes, a high abnormal concentration of activity ,just above the left side of the right diaphragm, appeared. Then a less intense diffuse activity could be seen in the right basal hemithorax (Figure 1). Repeat imaging at 6 hours showed evidence of progressive leakage of dialysis fluid from the peritoneal cavity into the right hemithorax. One day later, the patient underwent a surgical correction by pleural poudrage. CAPD was suspended for the next 10 days, and hemodialysis was repeated 3 times during this period with a . jugular catheter. A similar scintigraphic study was repeated 11 days later, and confirmed the absence of communica tion (Figure 2). On day 12, CAPD was reinstituted with small volumes (500 mL, 6 times/day), then with 3 x 1,500 mL/day from day 18. The patient was sent to convalescent ward for 1 month before his discharge. Transdiaphragmatic peritoneal leak is a welldocumented complication ofCAPD, and many procedures have been proposed for its diagnosis ( 1). These techniques include intraperitoneal instillation of methylene blue dye, peritoneography, computerized tomography, and peritoneal scintigraphy. The methylene blue technique detects usually only large diaphragmatic leaks; the use of methylene blue can be irritating for the peritoneum and pleura. Peritoneal scintigraphy proved to be a safe, simple, and sensitive method to detect and localize the transdiaphragmatic peritoneal leak. Moreover, the study can be repeated a few days later. The radiation dose is low, and there are no allergic reactions. Usually , whenever there is evidence of peri tonealpleural communication, CAPD has to be discontinued and replaced by hemodialysis at least for several months. In our patient, it was important to resume CAPD rapidly because of his unusual way of living.

Complications associated with central venous cannulation.

Abstract: Some complications, such as pneumothorax, air embolism, and arterial laceration, may occur immediately after insertion. Others, such as infection, hydrothorax, phlebitis, and thrombosis, may occur later.

Hydrothorax in a PD patient: successful treatment with intrapleural autologous blood instillation.

Abstract: An 80-year-old female developed massive right hydrothorax at the start of an IPD program. Peritoneal dialysis was interrupted and after complete evacuation of the pleural effusion, 40 ml of the patient's blood was infused into the right pleural cavity. For the first 2 days the patient maintained the Fowler position. Three weeks later, IPD was recommended, but pleural effusion reappeared early on. Infusion of a further 40 ml of the patient's blood was repeated after another pleural evacuation and the dialysis was again stopped for another 3-week period. Subsequently, IPD was restarted with only one-liter exchanges and the patient kept in the Fowler position during the dialysis sessions. After three weeks, standard IPD was started with the patient supine and two-liter exchanges. Hydrothorax did not re-appear and so far (12-month follow-up) no pleural effusion has been noticed. The patient feels well on IPD. Blood instillation was painless and caused one-day fever on the first time only. Pleurodesis achieved with autologous blood is a very safe, simple and effective way of treating hydrothorax in PD patients.

Effect of thoracic duct drainage on hydrostatic pulmonary edema and pleural effusion in sheep.

Abstract: Positive end-expiratory pressure (PEEP) increases central venous pressure, which in turn impedes return of systemic and pulmonary lymph, thereby favoring formation of pulmonary edema with increased microvascular pressure. In these experiments we examined the effect of thoracic duct drainage on pulmonary edema and hydrothorax associated with PEEP and increased left atrial pressure in unanesthetized sheep. The sheep were connected via a tracheostomy to a ventilator that supplied 20 Torr PEEP. By inflation of a previously inserted intracardiac balloon, left atrial pressure was increased to 35 mmHg for 3 h. Pulmonary arterial, systemic arterial, and central venous pressure as well as thoracic duct lymph flow rate were continuously monitored, and the findings were compared with those in sheep without thoracic duct cannulation (controls). At the end of the experiment we determined the severity of pulmonary edema and the volume of pleural effusion. With PEEP and left atrial balloon insufflation, central venous and pulmonary arterial pressure were increased approximately threefold (P less than 0.05). In sheep with a thoracic duct fistula, pulmonary edema was less (extra-vascular fluid-to-blood-free dry weight ratio 4.8 +/- 1.0 vs. 6.1 +/- 1.0; P less than 0.05), and the volume of pleural effusion was reduced (2.0 +/- 2.9 vs. 11.3 +/- 9.6 ml; P less than 0.05). Our data signify that, in the presence of increased pulmonary microvascular pressure and PEEP, thoracic duct drainage reduces pulmonary edema and hydrothorax.

Cardiotoxicity of Ionophores, Rat

Abstract: The ionophores, which will be described further in this paper, are polyether antibiotics. Rats that die from acute ionophore toxicity usually do not have remarkable gross cardiac lesions. Comparative LD50 values in rats given ionophores are presented in Table 2. Nonspecific changes such as vascular congestion and petechial hemorrhages on epicardial fat occur in animals that die soon after dosing. The rats that die following multiple exposure to ionophores administered via the feed have pale streaks or diffuse pallor of the ventricular myocardium. In subchronic studies, cardiomegaly with dilatation of right ventricle and gross evidence of congestive heart failure such as increased pericardial fluid, hydrothorax, pulmonary edema, ascites, and an enlarged, mottled liver occurs in some rats (Figs. 22,23).

Pleural effusion in 100 Malaysian patients.

Abstract: In a retrospective study of 100 patients with pleural effusion the final diagnosis was tuberculosis in 49, malignancy in 43, malignancy with tuberculosis, bacterial infection, hydrothorax with cirrhosis, reaction to pneumothorax in one each, and unknown in 4. Most of the effusions analysed were exudates (94%). Pleural biopsy was diagnostic in 46% of tuberculous effusions (13/28) and 67% of malignant effusions (20/30). Tuberculosis accounted for 87% of cases in patients aged 40 years and under. In this age group, patients with exudative pleural effusion and a positive tuberculin test are likely to have tuberculosis and early therapeutic trial is justified.

Struma Ovarii with Ascites and Hydrothorax (Meigs' Syndrome): A Case Report and Literature Review

Abstract: Struma ovarii is a rare type of germ cell tumor. The association of this neoplasm with ascites and hydrothorax (Meigs' syndrome) has been described in scattered case reports. A case of ascites, hydrothorax, and struma ovarii in a postmenopausal female is presented, and 14 similar cases are reviewed. In any case of benign ascites and hydrothorax occurring in the female, a benign ovarian neoplasm must be included in the differential diagnosis. (J GYNECOL SURG 7:243, 1991)

Iatrogenic hydrothorax after catheterization of the left internal jugular vein

Abstract: 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.

Pleurodesis with autologus blood in a CAPD patient with hydrothorax due to diaphragmatic communication.

Abstract: CAPD歴約6か月の51歳, 男性が, 突然, 除水量低下と体重増加が出現し, 胸部X線検査で右側胸水貯留が認められたため, 精査加療目的で入院となった. 末梢の浮腫および炎症所見は認められず, 胸水中糖濃度が血糖より高かったため, 腹膜灌流液の胸腔への移行を疑い, 99mTc-MAAを用いて確定診断を施行した, 本症の治療として, 胸水排出後に自家血の胸腔内注入による胸膜癒着術を試みたところ, 単独では無効であったが, CAPDの短期間中断およびその後に1回注液量を減少させたCAPDを併用することによって効果が得られた. 本療法は, 副作用なしに施行できたが, 永久的な胸膜の癒着が得られるかどうかは不明であり, 今後長期的に経過を観察する必要がある.

A case of hydrothorax due to subphrenic abscess complicated with refractory peritonitis under CAPD.

Abstract: CAPD歴16か月の47歳, 男性が腹膜炎のため入院した. 抗生剤の腹腔内投与が無効であり, 第6病日胸部X線検査で右側優位の胸水貯留, 腹部超音波検査で右側横隔膜下膿瘍が認められた. 腹膜灌流液の胸腔内への移行を疑い, Indocyanine Greenを用いて確定診断を施行し, 胸水が腹腔由来であることを確認した. 抗生剤の全身投与も効果なく難治性となったため, 膿瘍ドレナージおよび胸腔ドレナージを施行し, CAPDを中止した. これにより胸水の減少とともに腹膜炎も速やかに改善した. 本症例は腹膜炎から横隔膜下膿瘍が形成され, 横隔膜の脆弱部から腹膜灌流液が胸腔内に移行したものである. 腹腔と胸腔を交通する腹膜炎のため治癒が遷延したものと考えられた.