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Subarachnoid-pleural fistula in an infant treated with mechanical positive-pressure ventilation

Frédéric V Valla1

  • 1Pediatric Intensive Care Unit, Debrousse Pediatric University Hospital, Lyon, France. frederic.valla@chu-lyon.fr

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 10, 2007
PubMed

Insights

This case report details a pediatric subarachnoid-pleural fistula diagnosed using beta2-transferrin and MRI. Non-surgical positive-pressure ventilation led to successful fistula closure.

Area of Science:

  • Neurology
  • Pulmonology
  • Pediatric Surgery

Background:

  • Subarachnoid-pleural fistula is a rare condition often resulting from trauma or surgery.
  • Diagnosis can be challenging, requiring specific biomarkers and advanced imaging techniques.

Observation:

  • A 9-month-old boy developed severe pleural effusion post-posterior chest wall surgery.
  • The patient presented with symptoms suggestive of a cerebrospinal fluid leak into the pleural space.

Findings:

  • Beta-2 transferrin isolation in pleural fluid confirmed cerebrospinal fluid (CSF) presence.
  • Magnetic resonance cisternography precisely localized the subarachnoid-pleural fistula.
  • The fistula spontaneously closed with non-invasive bilevel positive-pressure ventilation and chest drainage, avoiding surgery.

Implications:

  • Beta-2 transferrin is a reliable diagnostic marker for subarachnoid-pleural fistula.
  • Non-invasive positive-pressure ventilation presents a viable alternative to surgery for treating pediatric subarachnoid-pleural fistulas.
  • This approach may reduce CSF flow, promoting spontaneous fistula closure and improving patient outcomes.
Abstract

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