RESUMEN
Hepatic hydrothorax is a rare complication of portal hypertension. The optimal treatment for this condition is liver transplantation. Liver transplantation is significantly more manageable in children who weigh more than 8 kg. Here, an implantable pleural access device was used in a 5-month-old infant for painless iterative punctures to relieve respiratory symptoms, while waiting for liver transplantation and the patient's growth. The patient underwent successful transplantation 3 months later with a more optimal weight.
Asunto(s)
Atresia Biliar/complicaciones , Hidrotórax/terapia , Atresia Biliar/terapia , Manejo de la Enfermedad , Humanos , Hidrotórax/fisiopatología , Lactante , MasculinoRESUMEN
INTRODUCTION: Readmission and death in cirrhosis are common, expensive, and difficult to predict. Our aim was to evaluate the abilities of multiple artificial intelligence (AI) techniques to predict clinical outcomes based on variables collected at admission, during hospitalization, and at discharge. METHODS: We used the multicenter North American Consortium for the Study of End-Stage Liver Disease (NACSELD) cohort of cirrhotic inpatients who are followed up through 90-days postdischarge for readmission and death. We used statistical methods to select variables that are significant for readmission and death and trained 3 AI models, including logistic regression (LR), kernel support vector machine (SVM), and random forest classifiers (RFC), to predict readmission and death. We used the area under the receiver operating characteristic curve (AUC) from 10-fold crossvalidation for evaluation to compare sexes. Data were compared with model for end-stage liver disease (MELD) at discharge. RESULTS: We included 2,170 patients (57 ± 11 years, MELD 18 ± 7, 61% men, 79% White, and 8% Hispanic). The 30-day and 90-day readmission rates were 28% and 47%, respectively, and 13% died at 90 days. Prediction for 30-day readmission resulted in 0.60 AUC for all patients with RFC, 0.57 AUC with LR for women-only subpopulation, and 0.61 AUC with LR for men-only subpopulation. For 90-day readmission, the highest AUC was achieved with kernel SVM and RFC (AUC = 0.62). We observed higher predictive value when training models with only women (AUC = 0.68 LR) vs men (AUC = 0.62 kernel SVM). Prediction for death resulted in 0.67 AUC for all patients, 0.72 for women-only subpopulation, and 0.69 for men-only subpopulation, all with LR. MELD-Na model AUC was similar to those from the AI models. DISCUSSION: Despite using multiple AI techniques, it is difficult to predict 30- and 90-day readmissions and death in cirrhosis. AI model accuracies were equivalent to models generated using only MELD-Na scores. Additional biomarkers are needed to improve our predictive capability (See also the visual abstract at http://links.lww.com/AJG/B710).
Asunto(s)
Cirrosis Hepática/fisiopatología , Aprendizaje Automático , Mortalidad , Readmisión del Paciente/estadística & datos numéricos , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Antibacterianos/uso terapéutico , Ascitis/etiología , Ascitis/fisiopatología , Ascitis/terapia , Reglas de Decisión Clínica , Estudios de Cohortes , Enfermedad Hepática en Estado Terminal , Femenino , Fármacos Gastrointestinales/uso terapéutico , Hemorragia Gastrointestinal/epidemiología , Encefalopatía Hepática/epidemiología , Humanos , Hidrotórax/etiología , Hidrotórax/fisiopatología , Infecciones/epidemiología , Enfermedades Renales/epidemiología , Lactulosa/uso terapéutico , Cirrosis Hepática/complicaciones , Cirrosis Hepática/terapia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Paracentesis , Inhibidores de la Bomba de Protones/uso terapéutico , Curva ROC , Reproducibilidad de los Resultados , Rifaximina/uso terapéutico , Índice de Severidad de la Enfermedad , Máquina de Vectores de Soporte , Desequilibrio Hidroelectrolítico/epidemiología , beta-Lactamas/uso terapéuticoRESUMEN
We describe the case of a 84-year-old woman with a right ventricular-peritoneal shunt and a left-sided pleural effusion, the analysis of which was positive for cerebrospinal fluid. We consider the potential causative mechanisms. Our patient was managed conservatively due to her frailty, the effusion being asymptomatic and her preference not to pursue further invasive diagnostic testing. This case report is unique due to the contralateral nature of the effusion to the shunt, which has not been described before in the literature.
Asunto(s)
Hidrotórax/líquido cefalorraquídeo , Derrame Pleural/diagnóstico por imagen , Derivación Ventriculoperitoneal/instrumentación , Anciano de 80 o más Años , Tratamiento Conservador , Femenino , Fragilidad , Humanos , Hidrotórax/fisiopatología , Hidrotórax/terapia , Derrame Pleural/etiologíaRESUMEN
BACKGROUND AND OBJECTIVES: Plasminogen activator inhibitor-1 (PAI-1) is a fibrinolytic system enzyme whose role in various fibrinolytic processes is currently unknown. In clinical manifestations of pleural liquids of diverse etiology, various levels of fibrinolytic activity can be observed-parapneumonic processes tend to loculate in fibrin septa, while malignant pleural effusion (MPE) does not. The purpose of this study was to determine possible differences in PAI-1 levels in pleural effusions of varied etiology. MATERIAL AND METHODS: PAI-1 level in pleural effusion and serum was determined in 144 patients with pleural effusions of various etiology (cardiac hydrothorax-42 patients (29.2%), MPE-67 patients (46.5%), parapneumonic pleuritis-27 (18.8%), tuberculous pleuritis-6 patients (4.1%), pancreatogenic pleuritis-1 patient (0.7%) and pulmonary artery thromboembolism with pleuritis-1 patient (0.7%)). RESULTS: The median PAI-1 level (ng/mL) was the highest in the parapneumonic pleuritis group both in the effusion and the serum, with values of 291 (213-499) ng/mL and 204 (151-412) ng/mL, respectively, resulting in a statistically significant difference (p < 0.001) from the cardiac hydrothorax and MPE groups. However, there was no statistically significant difference between PAI-1 levels in the pleural effusion and serum in the cardiac hydrothorax and MPE groups. CONCLUSION: The PAI-1 level in MPE and cardiac hydrothorax was statistically significantly lower than in parapneumonic pleuritis.
Asunto(s)
Hidrotórax/sangre , Inhibidor 1 de Activador Plasminogénico/análisis , Derrame Pleural Maligno/sangre , Pleuresia/sangre , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hidrotórax/fisiopatología , Letonia , Masculino , Persona de Mediana Edad , Inhibidor 1 de Activador Plasminogénico/sangre , Derrame Pleural Maligno/fisiopatología , Pleuresia/fisiopatologíaRESUMEN
Hepatic hydrothorax is a challenging complication of cirrhosis related to portal hypertension with an incidence of 5-11% and occurs most commonly in patients with decompensated disease. Diagnosis is made through thoracentesis after excluding other causes of transudative effusions. It presents with dyspnea on exertion and it is most commonly right sided. Pathophysiology is mainly related to the direct passage of fluid from the peritoneal cavity through diaphragmatic defects. In this updated literature review, we summarize the diagnosis, clinical presentation, epidemiology and pathophysiology of hepatic hydrothorax, then we discuss a common complication of hepatic hydrothorax, spontaneous bacterial pleuritis, and how to diagnose and treat this condition. Finally, we elaborate all treatment options including chest tube drainage, pleurodesis, surgical intervention, Transjugular Intrahepatic Portosystemic Shunt and the most recent evidence on indwelling pleural catheters, discussing the available data and concluding with management recommendations.
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Hidrotórax/terapia , Cirrosis Hepática/terapia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/epidemiología , Hidrotórax/fisiopatología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Cirrosis Hepática/fisiopatología , Valor Predictivo de las Pruebas , Factores de Riesgo , Toracocentesis , Resultado del TratamientoRESUMEN
BACKGROUND: Treatment of hepatic hydrothorax (HH) generally involves sodium restriction, diuretics, and serial thoracentesis. In more advanced cases, transjugular intrahepatic portosystemic shunt and liver transplantation may be required. Previously, indwelling tube drainage has been avoided due to concerns regarding high complication rates and overall poor outcomes. Recently, indwelling pleural catheters (IPCs) have been proposed as a novel treatment option for HH. METHODS: This study was a retrospective review of patients who had undergone IPC placement for HH over a 10-year period at a large liver transplant referral center. We tracked outcomes, including complication rates and liver transplantation, as well as biomarkers of nutritional status. RESULTS: Sixty-two patients underwent IPC placement between 2007 and 2017, with 33 IPCs (53%) placed as a bridge to liver transplantation. Complications were recorded in 22 patients (36%); empyema was the most common, diagnosed in 10 patients (16.1%). Ten patients evaluated for liver transplantation underwent successful transplantation following IPC placement. There were statistically significant decreases in both BMI and serum albumin levels following IPC placement. CONCLUSIONS: IPCs represent a potential treatment for refractory HH and should be used with caution in patients eligible for liver transplantation. Ideally, IPC use for these patients would be evaluated by a multidisciplinary team. IPC use may lead to small decreases in BMI and serum albumin levels in patients over time.
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Catéteres de Permanencia , Empiema Pleural/terapia , Hidrotórax/terapia , Fallo Hepático/cirugía , Trasplante de Hígado/efectos adversos , Toracocentesis/métodos , Anciano , Causas de Muerte , Estudios de Cohortes , Empiema Pleural/diagnóstico por imagen , Femenino , Humanos , Hidrotórax/diagnóstico por imagen , Hidrotórax/fisiopatología , Fallo Hepático/diagnóstico , Trasplante de Hígado/métodos , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Ascitis , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatocolangiografía por Resonancia Magnética/métodos , Hidrotórax , Conductos Pancreáticos/diagnóstico por imagen , Fístula Pancreática , Pancreatitis Aguda Necrotizante/complicaciones , Amilasas/análisis , Ascitis/diagnóstico , Ascitis/etiología , Ascitis/fisiopatología , Ascitis/cirugía , Femenino , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiología , Hidrotórax/fisiopatología , Hidrotórax/cirugía , Persona de Mediana Edad , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiología , Fístula Pancreática/fisiopatología , Fístula Pancreática/cirugía , Paracentesis/métodos , Radiografía Torácica/métodos , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
OBJECTIVE: To determine the frequency of hepatic hydrothorax and its association with Child Pugh Class in patients with liver cirrhosis. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, (Ward- 7), from June 2012 to May 2013. METHODOLOGY: All patients with established diagnosis of decompensated chronic liver disease were included. Detailed history, thorough physical examination, routine laboratory investigations, chest X-ray and abdominal ultrasound were carried out in all patients to find out the presence of pleural effusion and ascites, respectively. Fifty milliliters of pleural fluid was aspirated in all patients with pleural effusion using the transthoracic approach, taking ultrasound guidance, wherever required. Fluid was sent for microscopic, biochemical, and microbial analysis. SBEM defined if pleural fluid with polymorphonuclear (PMN) cell count > 500 cells/mm3 or positive culture with PMN cell count > 250 cells/mm3 with exclusion of a parapneumonic effusion. RESULTS: Two hundred and six patients met the inclusion criteria, with mean age of 41.25 ±13.59 years. Among them, 149 (72.3%) were males and 57 (27.7%) females. Twenty-three (11.2%) had hydrothorax; right sided involvement was in 18 (78.3%) subjects, 3 (13%) had left sided while bilateral pleural effusion was found in 2 (8.7%) cases. SBEM was found in 07 (30.43%) cases. Mean serum albumin 3.125 ±0.71 gram/dl. There was association between serum albumin levels and hydrothorax. Asignificant association of hydrothorax with Child Pugh scoring system (p=0.018), but not with serum albumin (p=0.15). CONCLUSION: The frequency of hepatic hydrothorax has a significant association with hepatic function as assessed by Child Pugh scoring system, but not with serum albumin.
Asunto(s)
Ascitis/complicaciones , Hidrotórax/epidemiología , Hidrotórax/etiología , Cirrosis Hepática/complicaciones , Adulto , Ascitis/fisiopatología , Empiema Pleural/fisiopatología , Femenino , Humanos , Hidrotórax/fisiopatología , Incidencia , Recuento de Leucocitos , Cirrosis Hepática/fisiopatología , Masculino , Persona de Mediana Edad , Derrame Pleural/etiología , Albúmina SéricaRESUMEN
Urinothorax is defined as the presence of urine in the pleural cavity. Leakage from the urinary tract can cause urinoma with retroperitoneal urine collection, and secondarily, urinothorax. We report the case of a 35-year-old female who presented with dyspnoea and right-sided chest pain. Chest radiograph revealed a right-sided pleural effusion. The patient had undergone left-sided ovarian cystectomy three months ago, had sustained a left-sided ureteric injury that required ureteric stent placement. Urinothorax was suspected as a consequence of ureteric injury; pleural fluid to serum creatinine ratio was found to be greater than one, confirming the diagnosis.
Asunto(s)
Hidrotórax , Ovariectomía/efectos adversos , Complicaciones Posoperatorias , Uréter , Derivación Urinaria/efectos adversos , Urinoma , Adulto , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Disnea/diagnóstico , Disnea/etiología , Femenino , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiología , Hidrotórax/fisiopatología , Hidrotórax/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Reoperación/métodos , Resultado del Tratamiento , Uréter/diagnóstico por imagen , Uréter/lesiones , Uréter/cirugía , Derivación Urinaria/métodos , Urinoma/complicaciones , Urinoma/diagnóstico , Urinoma/cirugíaRESUMEN
BACKGROUND: Pleural effusions may result from intra-abdominal processes and sometimes present with dramatic clinical consequences. We present 2 cases of recurrent hydrothorax requiring surgical repair of diaphragmatic defects and describe when surgery may be the best treatment modality. PATIENT 1: : A 63-year-old man with end-stage renal disease requiring peritoneal dialysis presented with dyspnea on exertion that progressed to cardiac arrest. He was found to have a tension hydrothorax that was initially stabilized with thoracentesis and tube thoracostomy. He eventually underwent surgical repair of fenestrations with complete resolution of his effusion. PATIENT 2:: A 52-year-old man with recurrent hydrothorax in the context of hepatitis C cirrhosis and hepatocellular carcinoma following radiofrequency ablation to his liver had recurrent admissions with dyspnea and a large pleural effusion. When medical therapy failed, he underwent surgical repair of a large diaphragmatic defect. CONCLUSIONS: Hydrothorax related to peritoneal dialysis or cirrhosis may cause life-threatening scenarios in which medical management may stabilize the patient. Ultimately, surgical corrections of diaphragmatic defects may be necessary for definitive management in selected patients. Although these scenarios are rare, clinicians should be aware of these possibilities as early collaboration between medical and surgical services is essential for optimal patient care.
Asunto(s)
Carcinoma Hepatocelular/complicaciones , Diafragma/cirugía , Hidrotórax/cirugía , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/complicaciones , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Carcinoma Hepatocelular/cirugía , Diafragma/patología , Drenaje/métodos , Disnea/terapia , Resultado Fatal , Paro Cardíaco/etiología , Humanos , Hidrotórax/etiología , Hidrotórax/fisiopatología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Derrame Pleural/etiología , Derrame Pleural/fisiopatología , Derrame Pleural/terapia , Pleurodesia/métodos , Recurrencia , Talco/administración & dosificación , Toracoscopía/métodosRESUMEN
Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis in the absence of cardiopulmonary disease. The estimated prevalence among patients with liver cirrhosis is approximately 5-6%. The pathophysiology involves the passage of ascitic fluid from the peritoneal cavity to the pleural space through diaphragmatic defects. The diagnosis is made from clinical presentation and confirmed by diagnostic thoracentesis with pleural fluid analysis. The initial medical management is sodium restriction and diuretics, but liver transplantation provides the only definitive therapy. For patients who are not transplant candidates and those who await organ availability, other therapeutic modalities that are to be considered include transjugular intrahepatic portosystemic shunt placement, videoassisted thoracoscopic surgery repair, pleurodesis, and vasoconstrictors (eg, octreotide and terlipressin). The primary therapeutic goals are to reduce ascitic fluid production and improve symptoms to bridge the time for liver transplantation.
Asunto(s)
Enfermedad Hepática en Estado Terminal/tratamiento farmacológico , Enfermedad Hepática en Estado Terminal/terapia , Hidrotórax/tratamiento farmacológico , Hidrotórax/terapia , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/fisiopatología , Enfermedad Hepática en Estado Terminal/cirugía , Humanos , Hidrotórax/complicaciones , Hidrotórax/diagnóstico , Hidrotórax/fisiopatología , Hidrotórax/cirugía , Trasplante de Hígado , Pleurodesia , Derivación Portosistémica Intrahepática TransyugularRESUMEN
OBJECTIVES: The objective of this study was to evaluate to what extent lung compliance is affected by the individual and combined action of lung resection and hydrothorax in an animal model. METHODS: Anaesthetized and mechanically ventilated rabbits (weight range 2 ÷ 2.2 kg) were randomized in two groups: (i) experimental hydrothorax (from 2 to 8 ml) (n = 5) and (ii) right lower lobe lobectomy (n = 4) and right middle plus lower lobe resection (n = 2). To obtain lung compliance, we measured alveolar, oesophageal pressures and lung volume during slow inflation manoeuvres in control conditions and after hydrothorax or lung resection. Lung compliance was estimated as the change in lung volume divided by the change in transpulmonary pressure. Based on the changes in compliance of the whole lung, we calculated the corresponding changes in compliance of the right lung, which was directly exposed to unilateral hydrothorax and lobectomy. RESULTS: Average total lung compliance in the control was 3.3 ± 0.8 (SD) ml/cmH2O. Eight millilitres of hydrothorax significantly decreased (P < 0.001) lung compliance to 2.7 ± 0.7 ml/cmH2O and increased pleural liquid pressure at the bottom of the cavity from -1 cmH2O up to â¼ 2.5-3 cmH2O. Resection of the right lower lobe significantly decreased (P < 0.001) lung compliance to 1.75 ± 0.3 ml/cmH2O. Resection of the right middle plus lower lobes significantly decreased (P < 0.001) lung compliance to 1.52 ± 0.4 ml/cmH2O. CONCLUSIONS: Following hydrothorax, the decrease in right lung compliance (â¼ 45%) was much greater than that expected based on the estimated decrease in right lung volume (20%). We attribute this difference to the fact that hydrothorax causes the lung to be exposed to positive, rather than sub-atmospheric, pressure, causing atelectasis. Following lobectomy, right lung compliance decreased by 62 and 80% for estimated decreases in lung volume of 30 and 60%. This difference could reflect inaccuracy in the estimate of lung volume reduction based on resected weight and/or surgical damage. We conclude that potential detrimental effects of hydrothorax and lobar resection decrease lung compliance and expose the lung to the risk of over-distension when a chest drain is applied.
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Hidrotórax/fisiopatología , Rendimiento Pulmonar/fisiología , Pulmón/fisiopatología , Pulmón/cirugía , Animales , Fenómenos Biomecánicos/fisiología , Modelos Animales de Enfermedad , Masculino , Neumonectomía , Presión , ConejosRESUMEN
Se analiza el caso clínico de un paciente de 61 años, alcoholista, con hidrotórax unilateral derecho y signos clínicos de insuficiencia hepatocítica crónica planteándose como etiología del derrame el hidrotórax hepático. A propósito de este caso clínico se discuten los criterios diagnósticos de esta entidad, forma de estudio, patrones evolutivos, complicaciones y la eficacia de las distintas opciones terapéuticas
Asunto(s)
Humanos , Masculino , Anciano , Cirrosis Hepática Alcohólica/complicaciones , Hidrotórax/cirugía , Hidrotórax/etiología , Hidrotórax/diagnóstico , Hidrotórax/fisiopatologíaRESUMEN
Mirror syndrome is a rare condition that involves fetal hydrops, placentomegaly and severe maternal edema. The pathogenesis of this syndrome mimics endothelial dysfunction observed in pre-eclampsia. We report a case of maternal mirror syndrome caused by bilateral fetal hydrothorax that resolved after intrauterine pleuroamniotic shunt placement. At the time of the clinical manifestation there was an antiangiogenic state similar to that seen in pre-eclampsia, which resolved after fetal treatment. Our findings suggest that mirror syndrome is a manifestation of a broad spectrum of pathological conditions that induces an antiangiogenic state.
Asunto(s)
Hidropesía Fetal/diagnóstico , Hidrotórax/diagnóstico , Neovascularización Fisiológica , Preeclampsia/diagnóstico , Adulto , Antígenos CD/sangre , Cesárea , Diagnóstico Diferencial , Endoglina , Femenino , Humanos , Hidropesía Fetal/sangre , Hidropesía Fetal/fisiopatología , Hidrotórax/sangre , Hidrotórax/fisiopatología , Proteínas de la Membrana/sangre , Preeclampsia/sangre , Preeclampsia/fisiopatología , Embarazo , Receptores de Superficie Celular/sangre , Síndrome , Receptor 1 de Factores de Crecimiento Endotelial Vascular/sangreAsunto(s)
Medios de Contraste/administración & dosificación , Hidrotórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Medios de Contraste/farmacocinética , Diafragma/patología , Drenaje , Femenino , Fístula/complicaciones , Humanos , Hidrotórax/etiología , Hidrotórax/fisiopatología , Inyecciones Intraperitoneales , Cirrosis Hepática Alcohólica/complicaciones , Cirrosis Hepática Alcohólica/diagnóstico por imagen , Manometría , Enfermedades Peritoneales/complicaciones , Enfermedades Pleurales/complicaciones , Hemorragia Subaracnoidea/complicacionesAsunto(s)
Infecciones por Bacteroides/complicaciones , Bacteroides fragilis , Infecciones Relacionadas con Catéteres/complicaciones , Hidrotórax/etiología , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/complicaciones , Anciano , Infecciones Relacionadas con Catéteres/microbiología , Femenino , Hernia Abdominal/complicaciones , Hernia Umbilical/complicaciones , Humanos , Hidrotórax/fisiopatología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Peritonitis/microbiología , Derrame Pleural/etiología , PresiónRESUMEN
Central venous catheter (CVC)-induced hydrothorax is a delayed complication after the placement of an indwelling subclavian or internal jugular central venous catheter. The catheter tips may cause long-lasting mechanical damages that lead to a slow erosion of the wall of the superior vena cava (SVC), thereby resulting in hydrothorax. The damage may stem from the catheter tips being positioned inappropriately or from the relocation of the catheter tip that was initially ideally positioned. We describe an 80-year-old woman with CVC-induced hydrothorax. She presented with spinal subdural hematoma and preoperatively underwent a multiple-lumen CVC insertion through her left subclavian vein. Her recovery course was uneventful after surgical hematoma removal and spinal cord decompression. However, thirty hours after the CVC placement, the patient began to suffer from an increasing dyspnea. The chest X-ray showed right-sided, massive pleural effusion and a widened mediastinum, requiring the removal of the CVC and the drainage of the pleural fluid. After these procedures, the respiratory status improved rapidly. The present case report suggests that the complication of a hydrothorax may occur after a patient's position changes, and it usually occurs in cases where the catheter tip was initially placed in the ideal position. Operators responsible for CVC placement have to be aware of this delayed complication and have the catheter tips remain in a consistently appropriate position.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Hidrotórax/etiología , Complicaciones Posoperatorias/etiología , Vena Cava Superior/lesiones , Anciano de 80 o más Años , Remoción de Dispositivos , Errores Diagnósticos , Drenaje , Disnea/etiología , Femenino , Insuficiencia Cardíaca/diagnóstico , Hematoma Subdural Espinal/cirugía , Humanos , Hidrotórax/diagnóstico , Hidrotórax/fisiopatología , Hidrotórax/cirugía , Derrame Pleural/etiología , Derrame Pleural/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Postura , Cuidados Preoperatorios , Vena Subclavia , Heridas Penetrantes/etiologíaRESUMEN
Thoracic surgery that requires resection of a portion of lung or of a whole lung profoundly alters the mechanical and fluid dynamic setting of the lung-chest wall coupling, as well as the water balance in the pleural space and in the remaining lung. The most frequent postoperative complications are of a respiratory nature, and their incidence increases the more the preoperative respiratory condition seems compromised. There is an obvious need to identify risk factors concerning mainly the respiratory function, without neglecting the importance of other comorbidities, such as coronary disease. At present, however, a satisfactory predictor of postoperative cardiopulmonary complications is lacking; postoperative morbidity and mortality have remained unchanged in the last 10 years. The aim of this review is to provide a pathophysiologic interpretation of the main respiratory complications of a respiratory nature by relying on new concepts relating to lung fluid dynamics and mechanics. New parameters are proposed to improve evaluation of respiratory function from pre- to the early postoperative period when most of the complications occur.