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Recurrent pleural effusion due to duropleural fistula
Parmeet Saini1, Leyda Callejas, Madhav Gudi
1Division of Pulmonary and Critical Care Medicine, New York Methodist Hospital, Brooklyn, NY.
Journal of Bronchology & Interventional Pulmonology
|July 4, 2014
Summary
A rare case of cerebrospinal fluid (CSF) in the pleural space was diagnosed in a patient with a history of spinal surgeries. This condition, known as a duropleural fistula, was confirmed by a specific biomarker.
Area of Science:
- Neurosurgery
- Pulmonology
- Medical Diagnostics
Background:
- A 76-year-old female patient with a history of multiple spinal surgeries presented with chronic, recurrent pleural effusion.
- Initial evaluation included thoracentesis to analyze the pleural fluid characteristics.
Observation:
- The pleural fluid was clear and "water-like," exhibiting characteristics of a transudate.
- Laboratory analysis revealed low total protein (0.2 g/dL), normal glucose (118 mg/dL), low LDH (76 U/dL), and a low nucleated cell count.
Findings:
- The fluid's unusual appearance prompted testing for cerebrospinal fluid (CSF).
- β-2-transferrin assay was positive, confirming the presence of CSF within the pleural space.
- These findings led to a diagnosis of a duropleural fistula.
Implications:
- This case highlights the importance of considering CSF leakage into the pleural space in patients with relevant surgical history and unexplained pleural effusions.
- The diagnostic utility of β-2-transferrin testing is emphasized for identifying duropleural fistulas.
- Accurate diagnosis is crucial for appropriate management and prevention of complications associated with CSF pleural effusion.
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