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Subarachnoid-pleural fistula in a child: the cause and treatment

Nalan Karabayir1, Demet Demirkol, Isik Odaman Al

  • 1Pediatric Intensive Care Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey. nalankarabayir@hotmail.com

Pediatrics International : Official Journal of the Japan Pediatric Society
|January 3, 2013
PubMed

Insights

A rare subarachnoid-pleural fistula caused cerebrospinal fluid hydrothorax in a child. Surgical repair was necessary after conservative treatments failed, leading to a full recovery.

Area of Science:

  • Neurosurgery
  • Thoracic Surgery
  • Pediatric Oncology

Background:

  • Subarachnoid-pleural fistula is a rare condition causing cerebrospinal fluid (CSF) to accumulate in the pleural space.
  • It can result from thoracolumbar trauma or iatrogenic injury, such as after thoracotomy.
  • This case involves a pediatric patient with ganglioneuroblastoma who developed respiratory distress post-thoracotomy.

Observation:

  • A two-year-old boy presented with respiratory distress and pleural effusion two months after surgery for ganglioneuroblastoma.
  • Magnetic Resonance Imaging (MRI) revealed a subarachnoid-pleural fistula.
  • Initial conservative management with chest tube insertion and external lumbar CSF drainage had temporary success.

Findings:

  • Recurrent respiratory distress necessitated reinsertion of the chest tube and lumbar drainage.
  • Craniospinal MRI and myelography precisely located the fistula.
  • Surgical restoration via a posterior approach with laminectomy successfully repaired the subarachnoid-pleural fistula.

Implications:

  • Subarachnoid-pleural fistulas often require invasive intervention as they rarely resolve spontaneously or respond to conservative measures.
  • Surgical repair is a viable and effective treatment for complex cases, leading to positive patient outcomes.
  • This case highlights the importance of timely diagnosis and surgical management for pediatric patients with CSF hydrothorax due to subarachnoid-pleural fistula.

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