Showing papers on "Hydrothorax published in 2010"
TL;DR: The recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates as the evidence is based on relatively few studies with only 305 patients included.
Abstract: Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading to hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt (TIPS) has been proposed as an alternative to paracentesis. TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates.
209 citations
TL;DR: TIPS can be successfully used to achieve symptomatic relief in patients with refractory hepatic hydrothorax and better clinical response afterTIPS and pre-TIPS MELD score less than 15 were associated with longer survival after TIPS.
112 citations
TL;DR: The etiology for hydrothorax specifically in the PD population is reviewed, with a conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.
Abstract: Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.
75 citations
TL;DR: The etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension are reviewed.
Abstract: Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis. It is defined as a pleural effusion in a patient with portal hypertension and no cardiopulmonary disease. The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. Thoracentesis and pleural fluid analysis are necessary for diagnosis. Initial management consists of sodium restriction, diuretics, and therapeutic thoracentesis. A transjugular intrahepatic portosystemic shunt may provide a bridge prior to liver transplantation. Spontaneous bacterial empyema is the infection of a preexisting hydrothorax. The more frequent bacteria involved are ENTEROBACTERIACEAE and gram-positive cocci. Antibiotic therapy is the cornerstone of therapy. This article reviews etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension.
43 citations
TL;DR: A 46-year-old case of the struma ovarii, presented with ascites, hydrothorax, right ovarian mass and elevated serum CA 125 level, was misdiagnosed for an ovarian malignancy at the first impression.
Abstract: The association of pseudo-Meigs' syndrome, elevation of CA 125 to the struma ovarii is a rare condition. So far only nine cases have been reported in English literature through MEDLINE search. Here we report a 46-year-old case of the struma ovarii, presented with ascites, hydrothorax, right ovarian mass and elevated serum CA 125 level. These findings were misdiagnosed for an ovarian malignancy at the first impression. Immediate resolution of the ascites, hydrothorax and normalization of the serum CA 125 level were followed by ovarian mass removal. Struma ovarii could be a rare cause of ascites, hydrothorax, ovarian mass and elevated CA 125. This rare condition should be considered in the differential diagnosis in patents with ascites and pleural effusions but with negative cytology.
31 citations
TL;DR: Liver transplantation is a good definitive therapeutic option for cirrhotic patients with hepatic hydrothorax and end-stage liver disease and the need of thoracentesis decreases in the posttransplant course, and the presence of preoperative liver transplantation did not have a significant negative influence on postoperative outcome.
Abstract: IntroductionHepatic hydrothorax is an uncommon, but severe complication of cirrhosis. Orthotopic liver transplantation (OLT) is the best option in case of end-stage liver disease. The impact of hepatic hydrothorax on pre-transplant and post-transplant courses has not been clearly investigated.Patien
28 citations
TL;DR: The case of a 48-year-old lady with advanced cirrhosis and recurrent transudative pleural effusion despite a sodium-restricted diet, optimal diuretic therapy and transjugular intrahepatic portosystemic shunt is described and a novel potential indication of the indwelling pleural catheter is presented.
Abstract: Refractory hepatic hydrothorax poses a challenging therapeutic dilemma, as treatment options are limited. Herein, we describe the case of a 48-year-old lady with advanced cirrhosis and recurrent trans
27 citations
TL;DR: This work investigated the utility and safety of contrast‐enhanced ultrasonography using Sonazoid in the diagnosis of hepatic hydrothorax and found it to be safe and effective.
Abstract: Background and Aim: We investigated the utility and safety of contrast-enhanced ultrasonography using Sonazoid in the diagnosis of hepatic hydrothorax
Methods: The study consisted of seven liver cirrhosis patients with hydrothorax and hydroperitoneum After obtaining informed consent, Sonazoid was injected intraperitoneally, and enhancement in the peritoneal and pleural cavities was observed
Results: In all patients, the peritoneal cavity was quickly enhanced after the Sonazoid injection The pleural cavity was enhanced in five of the seven patients, and these five patients were diagnosed with hepatic hydrothorax Two patients without enhancement of the pleural cavity were diagnosed with inflammatory hydrothorax
Conclusions: This is the first report to confirm transdiaphragmatic movement of ascitic fluid into the pleural cavity using contrast-enhanced ultrasonography with Sonazoid This method can safely detect ascitic flow in real time, and is thus very useful for the diagnosis of hepatic hydrothorax
23 citations
TL;DR: Thermal ablation with the use of artificial pleural effusion or ascites is a safe and effective treatment for liver tumors, and the technique can widen the indications of thermal ablation for liver tumor indications.
Abstract: Background and Objective: Percutaneous ultrasound-guided thermal ablation is one of the major treatment methods for liver cancer Tumor location close to the diaphragm or gastrointestinal tract was regarded as the treatment contraindication before due to poor visibility of the tumor or increased risk of thermal injury to the adjacent organs This study used artificial pleural effusion or ascites to extend the indications of thermal ablation for liver cancer Methods: Artificial pleural effusion (20 cases) or ascites (36 cases) was performed in 56 difficult cases of percutaneous thermal ablation for liver tumors The technical success rates, the rate of approaching the procedure goal, complications, and local treatment response were assessed Results: The technical success rates were 95% (19/20) for artificial pleural effusion and 100% (36/36) for artificial ascites, the achieve purpose rates were 100% (19/19) and 917% (33/36), the complete ablation rates were 842% (16/19) and 939% (31/33), respectively Coughing, transient hematuria, and subcutaneous effusion were observed in 3 patients after the procedure of artificial pleural effusion, and hydrothorax in the right chest occurred in 1 patient during the artificial ascites process Conclusions: Thermal ablation with the use of artificial pleural effusion or ascites is a safe and effective treatment for liver tumors, and the technique can widen the indications of thermal ablation for liver tumors
21 citations
TL;DR: For patients with hepatic hydrothorax, aggressive medical or surgical intervention might improve survival over supportive management, especially when resolution of hydrothOrax can be maintained for at least 3 months.
19 citations
TL;DR: This case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected, and is an important condition to recognize for the wider general medical community.
Abstract: Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid) scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis. Although our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.
Journal Article•
TL;DR: The present case report suggests that the complication of a hydrothorax may occur after a patient's position changes, and it usually occurs in cases where the catheter tip was initially placed in the ideal position.
Abstract: Central venous catheter (CVC)-induced hydrothorax is a delayed complication after the placement of an indwelling subclavian or internal jugular central venous catheter. The catheter tips may cause long-lasting mechanical damages that lead to a slow erosion of the wall of the superior vena cava (SVC), thereby resulting in hydrothorax. The damage may stem from the catheter tips being positioned inappropriately or from the relocation of the catheter tip that was initially ideally positioned. We describe an 80-year-old woman with CVC-induced hydrothorax. She presented with spinal subdural hematoma and preoperatively underwent a multiple-lumen CVC insertion through her left subclavian vein. Her recovery course was uneventful after surgical hematoma removal and spinal cord decompression. However, thirty hours after the CVC placement, the patient began to suffer from an increasing dyspnea. The chest X-ray showed right-sided, massive pleural effusion and a widened mediastinum, requiring the removal of the CVC and the drainage of the pleural fluid. After these procedures, the respiratory status improved rapidly. The present case report suggests that the complication of a hydrothorax may occur after a patient's position changes, and it usually occurs in cases where the catheter tip was initially placed in the ideal position. Operators responsible for CVC placement have to be aware of this delayed complication and have the catheter tips remain in a consistently appropriate position.
TL;DR: A case of complications of bilateral hydrothorax with cardiac tamponade by superior vena cava perforation due to continuous mechanical force of the looped central venous catheter tip against SVC wall after subclavian vein cannulation is reported.
Abstract: Central venous catheterization is typically used for the anesthetic management of patients undergoing a major surgery or care of patients in Intensive Care Unit (ICU). The occurrence of complications associated with central venous catheterization such as pneumothorax or vascular injury have decreased, while delayed complications such as hydrothorax, hydromediastinum, or cardiac tamponade have risen recently. We report a case of complications of bilateral hydrothorax with cardiac tamponade by superior vena cava perforation due to continuous mechanical force of the looped central venous catheter tip against SVC wall after subclavian vein cannulation.
TL;DR: The neonatal outcome may be improved limiting degree of prematurity; the presence of thoracoamniotic shunt is not per se an indication of premature birth, at least until GA >35 weeks and adequate pulmonary maturity is reached.
Abstract: Background. Spontaneous regression in the foetal period has been described for congenital hydrothorax. Hydrothorax may become larger and bilateral with hydrops and pulmonary hypoplasia. Prenatal thoracentesis and thoracoamniotic shunting of massive hydrothorax are indicated to decrease perinatal morbidity. In the neonatal period, persistent hydrothorax may require intensive care.Objective. To investigate neonatal outcome after thoracoamniotic shunting for congenital primary hydrothorax with hydrops/ polydramnios.Methods. Retrospective study on the postnatal management of a cohort of 28 congenital primary hydrothorax cases after thoracoamniotic shunting (January 2000–August 2005).Results. Congenital hydrotorax without major structural anomalies complicated by polidramnios and/or hydrops <34 weeks' gestation were the criteria accepted for thoracoamniotic shunting. There were neither pregnancy terminations nor utero deaths. Although 64% of cases were complicated by severe neonatal respiratory insufficiency, ...
TL;DR: A case of the extravasation of intravenous contrast into the pleural cavity after dynamic CT through a left subclavian catheter is reported.
Abstract: Central venous catheterization is associated with a large number of complications, such as pneumothorax, hydrothorax, hemothorax, phlebothrombosis, pericardial tamponade, air embolism, aberrant placement and line sepsis. There are many case reports of the extravasation of various central venous catheter fluids, including the intravenous fluids, total parenteral nutrition and chemotherapeutic agents into the pleural cavity and mediastinum. These have led to hydrothorax, hydromediastinum and pericardial effusions. We report a case of the extravasation of intravenous contrast into the pleural cavity after dynamic CT through a left subclavian catheter.
TL;DR: It is demonstrated that dexamethasone accelerates pleural fluid absorption in induced isosmotic hydrothoraces in mice and may partly account for the clinical observation of faster resolution of pleural effusions when corticosteroids are administered in patients with pleural Effusions of certain etiologies.
Abstract: This study assessed the effect of corticosteroid treatment in the clearance of hydrothoraces in mice. Twenty-four C57BL/6 mice were divided into four groups and were injected intrapleurally with 500 μL sterilized PBS-BSA 1% to create isosmotic hydrothoraces. Two groups served as control and two groups were treated with dexamethasone. The control groups received intraperitoneally PBS, while the corticosteroid treatment groups received dexamethasone (1 mg/kg), both 5 min after the induction of hydrothorax. Control and treated animals were sacrificed 2 and 4 h after the induction of hydrothorax, and pleural fluid volume was measured. The pleural fluid volume 2 and 4 h after the induction of hydrothoraces was significantly lower in the dexamethasone-treated group compared to the untreated group. The rate of pleural fluid absorption 2 and 4 h after the induction of hydrothoraces was significantly higher in the dexamethasone-treated groups. The present study demonstrated that dexamethasone accelerates pleural fluid absorption in induced isosmotic hydrothoraces in mice. This newly reported property of dexamethasone may partly account for the clinical observation of faster resolution of pleural effusions when corticosteroids are administered in patients with pleural effusions of certain etiologies.
TL;DR: A case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome is reported.
Abstract: Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.
TL;DR: Management requires revision of the lower end with repositioning the distal end back into the peritoneal cavity is required once the patient’s clinical condition stabilizes as was done in the present case.
Abstract: Sir, Intrathoracic migration of the distal end of the ventriculoperitoneal shunt is extremely uncommon. We came across this rare complication, managed successfully by thoracocentesis and shunt revision. A nine-mo-old child underwent a right side ventriculoperitoneal shunt for tuberculous meningitis with hydrocephalus. Routine X-ray post surgery revealed the distal shunt tip below the dome of diaphragm. Three mo after discharge the child presented to the casualty with severe respiratory distress. X- ray chest revealed hydrothorax with coiled distal end of the tube in the thorax with no part below the diaphragm suggesting a supradiaphragmatic intrathoracic migration of the shunt (Fig. 1). Emergency pleural tap was done to relieve the respiratory distress Once the child’s clinical condition was stabilized, revision of the distal end done. Very few cases of intrathoracic migration of the distal end of the shunt presenting with symptomatic hydrothorax. 1-5 Infants are more prone to become symptomatic, as in infants and young children less than 5 yr, the pleura cannot absorb significant cerebrospinal fluid. The intrathoracic migration of the shunt can be either supradiaphragmatic or transdiaphragmatic. 6 In supradiaphragmatic migration the site of entry into the chest is probably incorrect subcutaneous passage. Doh et al, reported incorrect subcutaneous passage under ribs confirmed by CT scan in a case of supradiaphragmatic migration of the shunt. 2 The intrathoracic migration in the present case is supradiaphragmatic as the chest X- ray revealed whole of the shunt tube coiled in the chest with no part below the diaphragm which could be possibly due to the accidental passage into pleural cavity either by passage under the ribs or in the supraclavicular fossa during tunneling. Management requires revision of the lower end with repositioning the distal end back into the peritoneal cavity is required once the patient’s clinical condition stabilizes as was done in the present case. Temporary exteriorization may be required in very sick children. Meeker et al reported a case of intrathoracic migration of the shunt in a female presenting with dyspnea in her early pregnancy which was managed by serial thoracocentesis as a temporary measure and shunt revision after delivery. 5
TL;DR: To the authors' knowledge, this is the first report of this complication after PRS, and percutaneous access is carried out using dilating systems generally considered to be less traumatic.
TL;DR: A case wherein left pneumothorax and right hydrothorax were simultaneously detected as delayed complications induced by a left subclavian CVC is reported.
TL;DR: A 59-year-old woman with end-stage renal disease presented to the emergency department with shortness of breath about one month after starting continuous ambulatory peritoneal dialysis.
Abstract: See also practice article by McGrath and Barber, page [1879][1]
A 59-year-old woman with end-stage renal disease presented to the emergency department with shortness of breath about one month after starting continuous ambulatory peritoneal dialysis. On examination, she had decreased breath sounds
TL;DR: A case of iatrogenic massive pleural effusion following subclavian vein catheterization necessitating intercostal tube drainage and mechanical ventilation is described, highlighting the importance of ensuring adequate positioning of the catheter after insertion through aspiration of venous blood.
Abstract: Since the introduction of central venous catheterization for monitoring of the venous pressure, fluid infusion and hyperalimentation, the literature has been full of serious life-threatening complications. Of these complications is the false positioning of the central venous catheter and subsequent development of pleural effusion. In this report we are describing a case of iatrogenic massive pleural effusion following subclavian vein catheterization necessitating intercostal tube drainage and mechanical ventilation. The case highlights the importance of ensuring adequate positioning of the catheter after insertion through aspiration of venous blood, immediate post insertion X-ray and the utilization of ultrasound guidance in cases with expected difficult catheterization.
TL;DR: This study presents one such case and shows autopsy findings consistent with hepatic hydrothorax without ascites, and presents CT imaging which shows the possible cause of death in the case of severe hydroThorax.
TL;DR: An uncommon complication of refractory hydrothorax following RFA is reported, which has attracted great interest due to its effectiveness and safety for small or unresected HCC.
Journal Article•
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TL;DR: Smith et al. as mentioned in this paper presented a 66-year-old Caucasian male with no past medical history presented to the emergency department (ED) complaining of severe retrosternal pain, which began immediately prior to arrival following an episode of vomiting.
Abstract: I mages I n E mergency M edicine Boerhaave’s Syndrome J. Shaun Smith DO Jennnifer W. McCallister MD Ohio State University Medical Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Columbus, OH Supervising Section Editor: Sean Henderson, MD Submission history: Submitted July 21, 2009; Revision Received September 2, 2009; Accepted September 14, 2009 Reprints available through open access at http://escholarship.org/uc/uciem_westjem [West J Emerg Med. 2010; 11(1):74-75.] Figure 2. Computed tomography of the chest with pneumo- hydrothorax and mediastinal air, where the black arrowhead indicates the hydrothorax, the white arrow indicates the pneumothorax, and the black arrow indicates the mediastinal air. Figure 1. Radiograph of left-sided pneumo-hydrothorax, where the black arrowhead indicates the hydrothorax and the white arrow indicates the pneumothorax. A 66-year-old Caucasian male with no past medical history presented to the emergency department (ED) complaining of severe retrosternal pain, which began immediately prior to arrival following an episode of vomiting. The patient had symptoms including nausea, vomiting and generalized abdominal discomfort for three days prior. The patient had been evaluated by a primary care physician earlier the day of presentation and was diagnosed with gastroenteritis and possible early small bowel obstruction per computed tomography (CT) scan of the abdomen and pelvis. The patient was released home with anti-emetics. On presentation to the ED the patient was in moderate distress secondary to pain and hemodynamically stable. Physical exam was remarkable for absent breath sounds over the left hemithorax. Chest Western Journal of Emergency Medicine radiography revealed a left-sided pneumo-hydrothorax (Figure 1). Subsequent CT of the chest also demonstrated pneumo- hydrothorax, as well as mediastinal air (Figure 2). Laboratory studies showed normal comprehensive metabolic panel and coagulation profile; however, the CK-MB was elevated at 6.70 ng/ml (3.60-5.00), and a leukocytosis of 11.9 TH/ul (4.0-9.0). Electrocardiograph showed normal sinus rhythm with a ventricular rate of 87. A 28 French chest tube was inserted, draining 600 mL of dark blood-tinged fluid. Based on radiographic findings and clinical presentation, esophageal rupture was the primary diagnosis. The patient was transferred to a tertiary center where Boerhaave’s was confirmed with a barium esophagram. Surgical repair was successfully performed. Patients classically present with chest pain, vomiting and subcutaneous emphysema. Pain may radiate to the neck, arm or back and is aggravated by deep breathing or swallowing. A myriad of other findings may be present, including hoarseness, Volume XI, no . 1 : February 2010
TL;DR: The continuous mechanical force of the catheter tip against the superior vena cava wall in combination with a hyperosmolar solution was considered to be the cause of the acute cellulitis and a delayed hydrothorax.
Abstract: We reported a case of 27-year-old woman who suffered a hydrothorax induced by a central venous catheter that had been placed to facilitate parenteral nutrition. The central venous catheter was inserted into the superior vena cava through the right subclavian vein. Chest radiograph after insertion revealed proper position of the tip. After a few days, the patient developed acute cellulitis of the right breast, and intravenous antibiotics were started. Four days later, 10 days after the insertion of the catheter, the patient suddenly developed dyspnea and tachycardia. Computed tomography scan of the chest showed massive pleural effusion in the right thorax and a mediastinal shift; the tip of the catheter had perforated the superior vena cava and was located in the right pleural space. Thoracic and subcutaneous drainage showed a fluid similar to parenteral nutrition. The continuous mechanical force of the catheter tip against the superior vena cava wall in combination with a hyperosmolar solution was considered to be the cause of the acute cellulitis and a delayed hydrothorax.
Journal Article•
TL;DR: Therapeutic alliance of verapamil and chemotherapeutics splanchnocoel perfusion could increase therapeutic effective rate of hydrothorax and seoperitoneum.
Abstract: Aim To observe the therapeutic effect of therapeutic alliance of verapamil and chemotherapeutics splanchnocoel perfusion.Methods 57 hydrothorax and seroperitoneum were splanchonocoel perfused with verapamil and chemotherapeutics,therapeutic effect evaluated after 2 courses of treatment.Results The general effective rate of splanchnocoel perfusion was 89.5%,including hydrothorax 88.9% and seroperitoneum 90.0%.The incidence of untoward reaction were nausea and vomiting 42.1%,mild pain 22.8%,fever 19.3%,leucocyte decrease 10.5%.Conclusion Therapeutic alliance of verapamil and chemotherapeutics splanchnocoel perfusion could increase therapeutic effective rate of hydrothorax and seoperitoneum.
01 Jul 2010
TL;DR: It is concluded that central venous catheters in premature infants should be inserted under ultrasonography or fluoroscopy, and their size ought to be adjusted to age, and a free outflow of blood should be obtained before they are used.
Abstract: BACKGROUND: Central venous cannulation is necessary for long-term parenteral nutrition in premature infants. Peripherally inserted long catheters are commonly used in these patients but even this relatively simple technique can end in serious complications. We present a case in which perforation of the vena cava and migration of the catheter to the intrapleural space resulted in multiple organ failure and death. CASE REPORT: A 700 g bw. infant, born at 28 weeks of gestation, was referred to our centre because of suspected bowel perforation. In the referring hospital, the infant had a central venous catheter inserted peripherally. The catheter migrated to the right intrapleural space, and parenteral formula was delivered over several hours to the right pleura, resulting in hydrothorax with serious compression of the lung and atelectasis. Emergency laparotomy did not reveal any pathology and a chest tube was inserted into the right pleura; the effusion fluid contained a large number fat particles. The child's condition worsened and he died 16 days after surgery because of multiple organ failure and sepsis. CONCLUSION: Accidental migrations of central venous catheters to the pleural space have been described by many authors. It can result in severe pneumonia, cardiac tamponade or sepsis and is often fatal. We conclude that central venous catheters in premature infants should be inserted under ultrasonography or fluoroscopy. Catheters should never be forced along vessels; their size ought to be adjusted to age, and a free outflow of blood should be obtained before they are used.
TL;DR: A 63-year-old woman presented with a week’s history of shortness of breath, 4 months of ankle swelling, and weight gain and developed aspiration pneumonia necessitating intubation and died within 4 days.