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Subarachnoid-pleural fistula: To drain or not to drain
E Moncomble1, S Al Kahf1, S Clerc2
1Service de pneumologie et de soins intensifs, hôpital Européen Georges-Pompidou, AP-HP, Paris, France.
Respiratory Medicine and Research
|July 8, 2021
Summary
Subarachnoid-pleural fistula (SPF) is a rare spine surgery complication. This case highlights diagnosis via pleural effusion and CSF analysis, with successful radiological repair.
Area of Science:
- Neurosurgery
- Thoracic Surgery
- Pulmonology
Background:
- Subarachnoid-pleural fistula (SPF) is a rare but serious complication following thoracic spine surgery.
- It can lead to significant pulmonary and neurological complications, including pleural effusion and intracranial hypotension.
- Current diagnostic and management strategies for SPF are not standardized.
Observation:
- A 48-year-old female developed SPF after a right transthoracic discectomy.
- Diagnosis was confirmed by abundant post-operative pleural effusion, subdural hematoma on CT, and cerebrospinal fluid markers in pleural fluid.
- Initial suspicion arose perioperatively.
Findings:
- The patient presented with both pulmonary compromise (pleural effusion) and neurological compromise (intracranial hypotension).
- Cerebrospinal fluid analysis of pleural fluid was crucial for diagnosis.
- A subdural hematoma was identified on head CT post-drainage.
Implications:
- This case underscores the importance of considering SPF in patients with unexplained pleural effusion post-thoracic spine surgery.
- Successful radiological intervention offers a minimally invasive treatment option.
- Standardizing diagnostic and management protocols for SPF is warranted to improve patient outcomes.
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