Showing papers on "Hydrothorax published in 2021"

Efficacy of TIPS Reduction for Refractory Hepatic Encephalopathy, Right Heart Failure, and Liver Dysfunction.

Abstract: OBJECTIVE. The purpose of this study was to determine clinical outcomes of patients undergoing TIPS reduction. MATERIALS AND METHODS. In this institutional review board-approved, HIPAA-compliant study, all TIPS reductions performed at two institutions from January 1, 2008 to January 31, 2016, were retrospectively identified. Patients were divided into two groups according to pre-TIPS symptoms: volume overload due to ascites or hydrothorax (VO; n = 14) or variceal bleeding (VB; n = 12). Patient demographics, pre-TIPS model for end-stage liver disease score, pre- and post-TIPS portosystemic gradients, and clinical parameters were recorded. The primary endpoint was change in symptoms of hepatic encephalopathy (HE; West Haven criteria), right heart failure, or liver dysfunction. Secondary endpoints included paracentesis rate for the VO group and rebleeding for the VB group. RESULTS. The degree of HE increased in 24 of 26 patients (92%) after TIPS placement and decreased in 24 of 26 patients (92%) after TIPS reduction. Mean West Haven scores for the VO group decreased after TIPS reduction (from 2.57 ± 0.97 [SD] to 1.07 ± 0.70; p < .001). Mean West Haven scores for the VB group also decreased after TIPS reduction (from 2.45 ± 0.89 to 1.27 ± 0.86; p = .007). Right heart failure improved in two of three patients (67%), and total bilirubin improved in one of three patients (33%). Follow-up data were available up to median of 134 days (interquartile range, 44-286). TIPS reduction led to an increased paracentesis rate compared with before TIPS placement in four of 14 patients with VO (29%). One patient had a stable paracentesis rate after TIPS reduction compared with before TIPS placement. Variceal rebleeding did not occur in any patients with VB after TIPS reduction. At 54 days after TIPS reduction, one of the 12 patients with VB (9%) experienced hematemesis due to an endoscopically proven band-related ulcer. CONCLUSION. TIPS reduction successfully resolved HE and refractory right heart failure in most patients. In patients with VB, TIPS reduction with variceal embolization results in a low risk of short-term recurrent VB. However, in patients with VO, ascites may return or worsen after TIPS reduction despite improvement in HE.

Pelvic mass, ascites, hydrothorax: a malignant or benign condition? Meigs syndrome with high levels of CA 125.

Abstract: Introduction Abdominal-pelvic mass, ascites and pleural effusion are suggestive of malignant metastatic ovarian cancer. This triad is also present in a rare benign condition called Meigs syndrome. Rarely this condition is associated with an increased CA 125 level. Case report A 62-year-old woman with a history of abdominal pain underwent an ultrasound (US) examination and a chest X-ray. The imaging revealed the presence of a large pelvic mass and ascites with a monolateral pleural effusion and a high level of the tumor marker CA 125. The patient underwent a total abdominal hysterectomy, salpingoophorectomy, removal of the pelvic mass, pelvic lymphadenectomy and peritoneal biopsies. The histology showed an ovarian fibrothecoma. Discussion The US analysis according to international ovarian tumor analysis simple rules revealed "inconclusive results"; the logistic regression model LR2 and Adnex suggested a high risk of malignancy. The presence of ascites and the size of the lesion associated with a high level of CA 125 affected the correct assessment of the risk of malignancy, exposing the patient to overtreatment. Conclusions Meigs syndrome is characterized by the resolution of symptoms after surgical removal of the pelvic mass. However, it mimics the clinical picture of a malignant metastatic ovarian cancer. Clinicians have to exclude ovarian cancer and recognize the syndrome to reduce inappropriate procedures.

A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula.

Abstract: Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

Transjugular intrahepatic portosystemic shunt (TIPS) placement at index portal hypertensive decompensation (anticipant TIPS) in cirrhosis and the role of early intervention in variceal bleeding and ascites

Abstract: Transjugular intrahepatic portosystemic shunt (TIPS) placement improves survival in patients with refractory/recurrent acute variceal bleeding (RAVB) and refractory ascites/hydrothorax. Recently, early TIPS was shown to reduce rebleeding and improve survival compared to the conventional TIPS. We aimed to study outcomes in patients with cirrhosis undergoing TIPS at first significant portal hypertensive (PHT) decompensation (termed anticipant TIPS) compared to those undergoing TIPS for recurrent or persistent PHT complications (conventional) and compared the former to matched controls on standard medical management (SMT). We retrospectively analyzed the clinical, biochemical, and liver disease severity parameters and survival at baseline and post-intervention in cirrhosis patients at two major hepatobiliary intervention centers undergoing anticipant (n = 27) or conventional TIPS (n = 30) and compared the former group to matched historical controls on SMT (n = 35). Baseline parameters were comparable between both the groups, including the Child-Pugh class and model for end-stage liver disease (MELD) scores. Length of stay in the intensive care unit, post-procedure admission rates, and sepsis events were higher among patients undergoing conventional TIPS (p < 0.05). Post-TIPS, at 1 year, overall and sub-grouped survivals were better in patients undergoing anticipant TIPS. On further sub-group analysis, based on the PHT events and stratified based on Child-Pugh and MELD scores, a higher proportion of patients survived after anticipant TIPS at 1 year. Compared to SMT, patients undergoing anticipant TIPS had significantly lesser hospitalizations, recurrence of varices, and ascites at 1 year, reducing hospital visits and financial burden. Anticipant TIPS at the first significant PHT event could improve liver-related events and survival compared to standard medical management and conventional TIPS, respectively.

Incidence of Spontaneous Pulmonary AVM Rupture in HHT Patients.

Abstract: The spontaneous rupture of pulmonary AVMs, resulting in pulmonary hemorrhage and hydrothorax, is a life-threatening complication. While this phenomenon has been previously reported, the true incidence is not yet known. This study retrospectively reviewed records of 801 HHT patients with pulmonary AVMs to identify a single lifetime episode of hemothorax or pulmonary hemorrhage secondary to pulmonary AVM rupture. The lifetime prevalence and incidence of pulmonary AVM rupture in HHT patients was 2.7% and 0.16% respectively. In these patients, AVM rupture represented the initial presentation of HHT in nine (40.9%) cases and was life-threatening in nine (40.9%) cases. All cases occurred in virgin lesions, and subsequent embolization was curative. While a feared complication, pulmonary AVM rupture is rare and is likely effectively prevented by existing embolization techniques and indications.

S100A2: A potential biomarker to differentiate malignant from tuberculous pleural effusion

Abstract: Background: S100 calcium binding protein A2 (S100A2)—which has been testified to have an abnormal expression in non-small cell lung cancer (NSCLC)—is considered as an effective biomarker in the diagnosis and prognosis of this malignancy. In this study, we detected the S100A2 levels in pleural effusion, aiming to evaluate its potential value in differentiating malignant pleural effusion (MPE) from tuberculous pleural effusion (TPE). Methods: We collected pleural effusion from 104 NSCLC patients with MPE and 96 tubercular pleurisy cases. Enzyme-linked immunosorbent assay (ELISA) was performed to measure the levels of S100A2 in these samples. Meanwhile, the serum S100A2 levels were also examined in same subjects. The data concerning the expression of those commonly-used markers, including CEA, CYFRA211 and NSE, were obtained from medical records. Results: Like other classified biomarkers, S100A2 had an over-expression in both pleural effusion and sera of the NSCLC patients compared with controls (P = 0.000), though having a lower P value. Receiver operating characteristic (ROC) analysis showed that the levels of S100A2 in pleural effusion (PE) could distinguish MPE from tuberculous pleurisy (Area Under the Receiver Operating Characteristic Curve (AUC) = 0.887), and its diagnostic value in hydrothorax was obviously higher than in serum (AUC = 0.709). Conclusion: Our results indicate that levels of S100A2 are significantly elevated in MPE, and that S100A2 may serve as a diagnostic biomarker for NSCLC patients with MPE. In further studies, we will validate our findings with a larger sample population.

Clinical Predictors of Morbidity and Mortality in Hospitalized Pediatric Patients With Ascites.

Abstract: OBJECTIVES Ascites is a pathologic buildup of fluid in the peritoneal cavity. Knowledge is lacking in clinical outcome in pediatric patients with ascites. We aim to identify and assess clinical variables, associated with morbidity and mortality in pediatric patients who are hospitalized with ascites. METHODS A retrospective cohort study was performed on patients ages 0 to 21 hospitalized at Johns Hopkins Hospital between 1983 and 2010 with an ICD-9 discharge diagnosis of ascites (789.5, 789.51, 789.59). A total of 518 pediatric patients were studied, all with a diagnosis of ascites during hospitalization. Study outcomes included hospital length of stay (LOS) as a proxy for morbidity and death at hospital discharge for mortality. Variables analyzed included demographic data, ascites etiology and grade, comorbidities, and laboratory markers. Variables were analyzed by log-linear regression and competing risk model. RESULTS Among the 3 age groups (0-5, 6-12, and 13-21), the 0 to 5 age group experienced significantly increased LOS (P < 0.001) and mortality (P = 0.027). Ascites etiology of veno-occlusive disease (VOD) and the presence of hydrothorax or thrombocytopenia was also significantly associated with increased LOS. Ascites with the etiology of congestive hepatopathy and the presence of grade 3 ascites, hepatic encephalopathy, hepatorenal syndrome, hydrothorax, hyponatremia, and thrombocytopenia were associated with increased mortality. Additionally, black pediatric patients have an increased risk of mortality (P = 0.027). Other factors including sex, leukopenia, portal vein thrombosis, and splenomegaly were not associated with LOS or mortality. CONCLUSIONS Morbidity and mortality in pediatric patients hospitalized with ascites are associated with specific demographic and clinical factors. Further studies are required to apply this knowledge to predict the clinical outcomes.

A Spectrum of Pulmonary Complications Occurring in End-Stage Renal Disease Patients on Maintenance Hemodialysis.

Abstract: Objective To investigate the trends of end-stage renal disease (ESRD) in patients undergoing maintenance hemodialysis (MHD) and find the correlation with effects on the pulmonary system in such patients. Methodology A multicentric prospective study was conducted in the city of Solapur, India. Data were collected from 250 patients through interpersonal interrogation using a questionnaire to capture basic demographic details, the history of ESRD, and relevant respiratory symptoms like breathlessness, cough, fever, etc. related to their disease. Symptoms that are likely associated with the pulmonary system were analyzed and referred to the pulmonology department. Appropriate diagnoses were made using relevant diagnostic tools like X-rays and sputum studies. The association between various disease attributes and pulmonary diagnoses was analyzed using the chi-square (χ2) test, with a p-value of value less than or equal to 0.05 considered statistically significant. Various socio-demographic variables, existing comorbidities, occupation-related risk factors, smoking history, past or current history of any respiratory conditions, the association between the causes of ESRD, time since the first dialysis and sociodemographic factors, and frequency of pulmonary complications were the other covariates in the study. Results Our study reports that 31.6% of our patients had significant impairment in their functioning due to respiratory complaints. The prevalence of respiratory complications was 27.2%. Major contributors were pleural effusion (33.8), pneumonia (25), pulmonary edema (20.58), pleuritis (11.76), collapse (8.8), tuberculosis (5.8), fibrosis (4.4), pericardial effusion (4.4), calcification (2.9), and hydrothorax (1.47). We report one case of Urinothorax as a rare cause of hydrothorax in such patients. Overall, our analysis found a significant association between non-reporting of respiratory complaints and acute admissions to the intensive care unit (ICU) with a respiratory cause at p-value 0.0076 with a greater predilection toward the rural populations. Conclusion Our study results highlight the prevalence of pulmonary complications in ESRD patients. The occurrence of pulmonary complications, irrespective of the presence of symptoms and a greater association between non-reporting of respiratory symptoms and acute admissions to the ICU, is a hallmark to consider the importance of history and clinical vigilance during patient visits.

Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax.

Abstract: OBJECTIVE The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax METHODS A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Queretaro, Mexico from January 2012 to July 2020 Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated RESULTS Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0-36+1) Two (57%) and 7 (200%) cases delivered within the first 24 h and 1 week after PAS, respectively Ten (286%) women had a short cervix before PAS, while 25 (714%) had normal preoperative CL Women with a short cervix showed lower mean interval between fetal intervention and delivery (24 vs 55 weeks, p = 001), and higher prevalence of PPROM (50 vs 12%, p = 001), as compared to women with a nonshort cervix Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (200 vs 0%, respectively, p < 005) and 1 week after PAS (500 vs 80%, respectively, p < 001) compared with pregnancies with normal preoperative CL CONCLUSION In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure

Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer.

Abstract: Background Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published. Case presentation A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021. Conclusions It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.

Catastrophic right-sided Candida empyema from spontaneous esophageal perforation.

Abstract: Right-sided empyema secondary to esophageal rupture are rare but reported in the medical literature. We describe an atypical CASE of right-sided empyema with Candida Tropicalis, Candida Glabrata, and Staphylococcus lugdenensis leading to a diagnosis of spontaneous esophageal rupture. We concluded that pleural effusion with fungal and multi-organism growth should immediately raise suspicion for underlying missed esophageal perforation. Prompt diagnosis of esophageal perforation can prevent fatal complications like pleuritis, pneumothorax, hydrothorax, pneumomediastinum, mediastinitis, acute respiratory distress syndrome, and septic shock.

Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis .

Abstract: Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.

Chemodectoma in a Dog

Abstract: Background : The chemodectoma is a rare neoplasm that originates from chemoreceptors located mainly in the aortic body, and carotid body and sinus, and responsible for detecting variations in blood pH, oxygen pressure and carbon dioxide. Dogs of brachiocephalic breeds and aged between 7 and 15 years have greater propensity. A neoplasm involves infiltrative growth in the vessels at the heart base, which leads to Congestive Heart Failure (CHF). The definitive diagnosis is performed by histopathological and/or immunohistochemical examination. The aim was to report a case of chemiodectoma in a dog, showed the disease clinical characteristics. Case : A 13-year-old male undefined breed dog was examinated in the medical clinic of small animal of Veterinary Hospital, Federal Rural University of Pernambuco (UFRPE) with respiratory effort, hyporexia, and edema in face, cervical, ventral thorax and thoracic limbs, with thirty days evoluted. About physical examination, we observed cachexia, orthopneic position, cyanosis and edema with a positive Godet sign, as well as 8% dehydration degree. Thoracic auscultation presented mixed dyspnea and muffled heart sounds. Chest radiography detected an radiopacity increase in pulmonary section and metastatic neoplastic process associated with pleural and pericardial effusion. Fluid therapy with lactated ringer and posterior thoracentesis in the right hemithorax region was performed for greater respiratory comfort for the patient. Hematological count and biochemical profiles stated normochromic normocytic anemia, relative and absolute lymphopenia, thrombocytopenia, as well as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The patient died after 12 hours when was submitted to necroscopic examination and histopathological evaluation. An infiltrative tumor of cardiac base was observed invading the light of the right atrium, obstructing the venous return, as well as a large thrombus located in the left ventricle and diffuse nodules in the lungs. Hydrothorax and hydroperitoneum were observed with serous fluid, with hepatic, renal and brain congestion, and duodenum hemorrhage. Histologically, the tumor was characterized as a chemodectoma with pulmonary metastasis. Discussion : Cardiac tumors are uncommon for canine population. A study sampled 729,265 dogs with observed incidence reaching 0.19%. The most common type is hemangiosarcoma with 69%, followed by chemiodectoma and lymphoma. Authors describe predisposed brachycephalic breeds such as Boxer, Boston Terrier and French Bulldog. In our case, the patient had elongated snout and undefined breed. Deregulation of chemoreceptors, which detect changes in pH and partial oxygen and carbon dioxide pressures, can result in hyperpnea and dyspnoea. Edema represents a deficit in venous return from the cranial and cervical regions, with consequent increase in hydrostatic pressure and liquid leakage into the thoracic cavity and subcutaneous tissue, thus inferring the Caudal Vena Cava Syndrome (CVCS). Tumors from the cardiac base, integrated with the large arteries insertion and adjacent to the atria, can cause pericardial effusion observed in this case. Chemodectomas are described as essentially benign tumors with low metastatic potential. In this case, pulmonary metastasis was detected. Surgical treatment is recommended when feasible. In this case, the patient had late veterinary care, in addition to the contraindication for surgery by the lung metastasis presence.

Meigs syndrome with pleural effusion as initial manifestation: A case report

Abstract: Background Meigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor, ascites, and pleural effusion. In postmenopausal women with pleural effusions, ascites, elevated CA-125 level, and pelvic masses, the probability of disseminated disease is high. Nevertheless, the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion. Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation. Case summary A 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month. Two months before admission, the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment. However, the pleural fluid accumulation persisted, and the patient began to experience dyspnea on exertion leading to admission. A computed tomography scan of the chest, abdominal ultrasound, and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass. Serum tumor markers showed raised CA-125. With a suspicion of a malignant tumor, the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma. On the seventh day postoperation, the patient had resolution of the right-sided pleural effusion. Conclusion Despite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125, clinicians should be aware about rare benign syndromes, like Meigs, for which surgery remains the preferred treatment.

Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient.

Abstract: An 89-year-old man with a history of multiple abdominal surgeries and ventriculoperitoneal (VP) shunt placement for normal pressure hydrocephalus presented for intractable abdominal bloating and scrotal swelling, for which imaging revealed massive ascites, bilateral hydrocele and small bilateral pleural effusions. Cardiac, hepatic and renal workup were insignificant. Culture and cytology of ascitic fluid were negative for infection or malignancy. Aetiology of the ascites as secondary to Cerebrospinal fluid (CSF) from the VP shunt was confirmed via ligation of the shunt. Sterile CSF ascites, hydrothorax and hydrocele are rare complications of VP shunt for hydrocephalus and are mostly presented in paediatric patients. We report the first known case of concurrent CSF ascites, hydrothorax and hydrocele in an elderly patient. We examine the difficulty of shunt replacement as a diagnostic and treatment modality in this age group and propose the use of reversible shunt ligation as a diagnostic modality.

Surgical correction of hydrothorax complicating pediatric peritoneal dialysis

Abstract: Hydrothorax complicating continuous cycling peritoneal dialysis (CCPD) is an uncommon event. Its presentation may occur shortly after or years after initiation of dialysis. Surgical intervention offers the advantage of direct visualization and repair of the diaphragmatic defect. Video assisted thoracoscopy surgery (VATS) has been increasingly used in identifying these defects to facilitate this repair. We present 2 pediatric cases who underwent successful direct surgical repair of diaphragmatic defects using VATS with return to CCPD. Initial approach with VATS should be strongly considered in patients in whom a lifetime change in modality has significant repercussions.

Method of minimally invasive intrauterine pleuro-amnial bypass grafting for intrauterine correction of hydrothorax in the fetus

Abstract: FIELD: medicine.SUBSTANCE: invention relates to the field of obstetrics and fetal surgery. Under ultrasound control and general anesthesia of the fetus, the introducer is introduced into the amniotic cavity, then into the pleural cavity of the fetus. After that, the obturator is removed. A conductor with a SDE-MED 3Fr stent, 49 mm long, is introduced into the introducer tube. The stent is squeezed out into the working area, the pigtail spiral is wrapped, which ensures its fixation in the pleural cavity. The introducer is removed. After surgical manipulation in the operating room, ultrasound monitoring of the fetal heartbeat and blood flow in the umbilical artery is performed. The next day after the operation, a repeated ultrasound examination is performed, the condition of the fetus, the position of the stent, and the amount of pleural effusion are assessed.EFFECT: method allows preserving the possibility of fetal lung development, prevents lung hypoplasia, reduces lung compression, increases the chance of newborn survival.1 cl, 1ex

Incidence and outcome of fetuses with severe hydrothorax and ductus venosus agenesis treated with thoracoamniotic shunt.

Abstract: Fetal hydrothorax is a congenital condition that can lead to hydrops and thus have a detrimental effect on perinatal survival. This might be mitigated by prenatal intervention by means of thoracoamniotic shunt (TAS) placement in selected cases. Association between severe fetal hydrothorax and anomalies of the fetal hepatic afferent venous system, such as ductus venosus agenesis (DVA), has been reported previously1. Considering the favorable prognosis of isolated DVA with intrahepatic umbilical venous drainage2 and the high risk of intrauterine death in the presence of massive pleural effusion with hydrops, we hypothesized that a minor malformation, such as DVA, in the presence of severe fetal hydrothorax should not be considered an exclusion criterion for TAS. We aimed to compare the outcome of fetuses with severe hydrothorax, according to whether they had DVA or normal ductus venosus (DV), treated with TAS in a single fetal surgery center at Children’s and Women’s Specialty Hospital of Querétaro, Querétaro, Mexico. Under ultrasound guidance, a double-pigtail catheter (Rocket of London, London, UK) was placed, as described by Rodeck et al.3. Inclusion criteria for TAS were singleton pregnancy with severe fetal hydrothorax and normal karyotype. Severe fetal hydrothorax was defined as an accumulation of fluid in the pleural cavity, with severe lung compression, severe mediastinal shift and/or hydrops. DVA was diagnosed if there was no connection between the portal system and the subdiaphragmatic vestibulum in the inferior vena cava, and the type of umbilical vein connection was classified as either to the portal venous system (intrahepatic drainage) or to any part of the systemic venous system (extrahepatic drainage)4 (Figure 1). Exclusion criteria were preoperative preterm prelabor rupture of membranes (PPROM), chromosomal abnormality, another structural anomaly and placenta previa. A total of 88 consecutive fetuses with hydrothorax were referred to our center during an 8-year period. DVA with intrahepatic umbilical venous drainage was identified in 12 (13.6% (95% CI, 6.44–20.76%)) cases, of which five (41.7%) had an additional structural or chromosomal abnormality and seven (58.3%) were isolated cases. Forty-seven cases did not fulfil the criteria for prenatal management, leaving a final population of 41 cases (including five fetuses with isolated DVA with intrahepatic drainage and 36 with normal DV) that were treated with TAS at a median gestational age (GA) of 30.6 (range, 22.3–37.1) weeks. No differences were observed in mean GA at diagnosis (30.2 vs 27.2 weeks; P = 0.16), rate of polyhydramnios (77.8% vs 60.0%; P = 0.39), mean GA at fetal intervention (30.9 vs 27.9 weeks; P = 0.09), mean operative time (13.4 vs 12.8 min; P = 0.87), mean GA at birth (35.7 vs 33.1 weeks; P = 0.08) or mode of delivery (Cesarean section rate, 91.7% vs 80.0%; P = 0.41) between cases with normal DV and those with intrahepatic DVA. In comparison to the group with normal DV, those with intrahepatic DVA had a non-significantly higher risk of intrauterine fetal demise (20.0% vs 2.8%; odds ratio (OR), 8.75 (95% CI, 0.45–168.6); P = 0.09), PPROM (40.0% vs 19.4%; OR, 2.76 (95% CI, 0.39–19.8); P = 0.30), preterm delivery at < 34 weeks (40.0% vs 19.4%; OR, 2.76 (95% CI, 0.39–19.8); P = 0.30) and neonatal death (60.0% vs 19.4%; OR, 6.21 (95% CI, 0.87–44.6); P = 0.06). Fetuses with severe hydrothorax and intrahepatic DVA had a significantly higher risk of perinatal death compared to those with normal DV morphology (80.0% vs 22.2%; OR, 14.0 (95% CI, 1.37–143.6); P < 0.01) (Figure 2). This is the first study to report on the incidence and outcome of TAS in fetuses with severe hydrothorax and DVA with intrahepatic umbilical venous drainage. We found that, despite prenatal intervention, the outcome was poor in this group, with only one (20%) fetus surviving the perinatal period. Therefore, our findings suggest that such cases may not benefit from fetal intervention. There have been previous case series that included fetuses

Non-immune fetal hydrops in late pregnancу: antenatal ultrasound monitoring and pregnancy outcomes in a series of 14 cases

Abstract: Background. Fetal hydrops is the accumulation of extracellular fluid in two or more fetal cavities, often in combination with subcutaneous edema. An isolated accumulation of fluid only in the abdominal, pleural, or pericardial cavities is described as ascites, pleural effusion (hydrothorax), pericardial effusion (hydropericardium). Features of the pathogenesis of non-immune hydrops fetalis (NIHF) are the follow: high hydrophilicity of fetal tissues, obstruction of the lymphatic vessels, impaired lymph return, congestive heart failure, obstruction of venous return, changes in fetal venous pressure. All these factors lead to the release of fluid from cells and tissues into the «third» spaces – the abdominal, thoracic, pericardial cavities, as well as the subcutaneous space. The oncotic pressure of fetal plasma proteins is not of great importance in the formation of the fetal circulating blood volume. Currently, all the links in the pathogenesis of hydrops fetalis syndrome with various etiological factors are not fully known. The prevalence of NIHF is unknown because it is difficult to collect relevant data; many cases of the disease are not diagnosed until intrauterine fetal death or may spontaneously resolve during the prenatal period. Currently, up to 90% of all cases of fetal dropsy are attributed to NIHF. Purpose – acquaintance of the medical community with the diagnosis and treatment of non-immune hydrops as well as the analysis of clinical features, ultrasound monitoring and perinatal outcomes of 14 cases of non-immune fetal hydrops onset in a second half of pregnancy. Materials and methods. The material for the study were publications and results of clinical trials found in the databases Scopus, Web of Science Core Collection and PubMed for the period 2009–2020 and the analytic report of the own series of 14 cases of non-immune hydrops fetalis (NIHF) of various origins. During the period of 2005–2020 under the supervision in the Ultrasound Department of Kharkiv regional hospital with regional perinatal center there were 14 pregnant women with NIHF diagnosed in a second half of pregnancy. Clinical features are described, ultrasound images and Doppler monitoring are given, perinatal / postnatal results are studied. Results and discussion. The analysis of clinical features, ultrasound monitoring and pregnancy outcomes of 14 cases of non-immune fetal hydrops developed in the second half of pregnancy in presented series was carried out. 6/14 fetuses had structural anatomical defects (lung sequestration, СDH, myasthenia gravis, megacystis and hydronephrosis, epidermolysis bullosa, meconium peritonitis, intestinal atresia). Mortality rate (including perinatal and infant losses) was as high as 9/14 cases (64.2%): 3 of antenatal, 4 of neonatal, 2 of infant death). Surgical treatment was performed on 2 newborns. 5 newborns had apparently a favorable clinical postnatal outcome. In 2 cases, spontaneous resolution with complete regression of hydrops was observed (parvovirus-B19 and idiopathic NIHF). Complete recovery of fetus (spontaneous regression of hydrops without any deterioration and pathological consequences) was observed in 1 case. Conclusions. Antenatal ultrasound monitoring of fetus with NIHF is based on the assessment of PSV CMA, ductus venous, umbilical vein, atrioventricular flow. According to the results of the study, it was revealed that the cardiovascular profile of the fetus with NIHF is disturbed earlier, and the placental profile and arterial Doppler-later. Normal umbilical artery Doppler do not exclude the possibility of an adverse outcome, including intrauterine fetal demise. Extended Doppler monitoring is essential at NIHF. All neonates with NIHF in an antenatal anamnesis require postnatal follow-up.

Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures.

Abstract: OBJECTIVE The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. METHODS A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. RESULTS Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. CONCLUSION In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.

Congestive heart failure in a young cat with excessive moderator bands (false tendons) in the left ventricle

Abstract: Left ventricular false tendons are fibrous or fibromuscular bands that transverse the ventricular cavity and have no attachment to the mitral valve in many species. In cats it is considered a congenital defect that is rarely related to clinical disease and death in adult cats. A 45 days-old mixed breed cat had a history of inappetence since birth. At the physical exam the patient was lethargic and presented restrictive dyspnoea. At necropsy, there were marked ascites, hydrothorax, hepatomegaly with enhanced lobular pattern (nutmeg liver), and the lungs were markedly diminished (compressive pulmonary atelectasis). The heart was enlarged due to marked dilation of the cardiac chambers. Moreover, multiple slightly whitish and irregular cord-like structures were connecting the posterior papillary muscle to the interventricular septum (excessive moderator bands /left ventricular false tendons) at the left ventricle. Microscopically, these structures were characterized by a marked proliferation of fibrous connective tissue intermixed with Purkinje cells and well-differentiated cardiomyocytes lined by a single layer of endocardium. This study described a case of excessive moderator bands (left ventricular false tendons) in a young cat associated with congestive heart failure and death.

Liver Failure and the Lungs

Abstract: Children with liver failure may have an acute respiratory failure following one or several simultaneous insults including hepatic encephalopathy, volume overload, pulmonary hemorrhage, pulmonary edema, acute lung injury, and other comorbidities such as ascites with intra-abdominal hypertension, hydrothorax, and muscle weakness due to poor nutritional conditions. It is necessary to understand the basic concepts of pediatric respiratory management as well as to be able to arrange individual respiratory management based on the pathophysiology of each mechanism.

Recurrent hydrothorax due to diaphragmatic perforation post hepatocellular carcinoma radiofrequency ablation: A case report

Abstract: 1Liver Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain 2Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain 3Thoracic surgery Unit, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain 4Radiology Unit, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain

Community-acquired pneumonia in children in the era of the COVID-19 pandemic. What has changed?

Abstract: During COVID-19 pandemic the issue of diagnosis and rational therapy of community-acquired pneumonia in children became acute. This is caused by difficulties in verification of the diagnosis of community-acquired pneumonia in the outpatient department, peculiarities of interpretation of the respiratory system lesions. The article presents clinical cases of communityacquired pneumonia in children admitted to the pulmonology department of a pediatric hospital. Clinical case 1. 5-year-old child, medical history: acutely fell ill, on 28.11.20, had a sore throat and fever up to 39.0 C. Received Kagocel, Miramistin, Nurofen. PCR for COVID-19 on 08.12.20 was positive, on 18.12.2020, 22.12.2020, 20.01.2021 - negative. Immunoassay (ELISA) on 12.23.20: IgM - 4.47, IgG - 255.25. Lung and pleural cavity ultrasound: echo signs of sharply pronounced interstitial syndrome, massive fibrinothorax on both sides, indirect signs of bronchopleural fistulas; lung radiography: bilateral polysegmental pneumonia, bilateral hydrothorax, bilateral fibrinothorax, with no marked progression; CT scan with IV contrast: CT picture of hydrothorax on the left, hydropneumothorax on the right, pleurisy on both sides, compression atelectasis of lower lobe segments of both lungs. With no marked progression. Treatment. Thoracentesis; antibiotic therapy, antimycotics, infusion therapy, immunotherapy, partial parenteral nutrition. Against the background of the therapy, positive dynamics was obtained. Clinical examples are also given: an 8-year-old child with suspected new coronavirus infection and a 5-year-old child with bilateral polysegmental pneumonia.

Bilateral Hydrothorax and Pneumomediastinum Caused by Parenteral Nutrition Extravasation From A Jugular Vein Venous Central Catheter: A Rare Presentation Of Acute Respiratory Failure

Abstract: Bilateral Hydrothorax and Pneumomediastinum Caused by Parenteral Nutrition Extravasation From A Jugular Vein Venous Central Catheter: A Rare Presentation Of Acute Respiratory Failure M. Cantalejo, H. Duran*, Y. Quijano, E. Vicente, V. Ferri, R. Caruso, I. Fabra, E. Diaz, L. Malave and R. Agressot Department of General Surgery, Department of Clinical Medical Sciences (Surgery Section), HM Sanchinarro University Hospital, San Pablo CEU University, Madrid, Spain; Foundation for the Development and Research of Oncological Surgery, Madrid, Spain