Cases reported "Hydrothorax"

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1/24. Thoracoscopic surgery and pleurodesis for pleuroperitoneal communication in patients on continuous ambulatory peritoneal dialysis.

    Two patients on continuous ambulatory peritoneal dialysis (CAPD) developed right massive hydrothorax and were diagnosed as having pleuroperitoneal communication. Thoracoscopic surgery and pleurodesis were performed. It showed that one was caused by multiple flaws in the diaphragm and that the other was attributable to multiple blebs in the diaphragmatic dome. After the procedure, both of them had no recurrence of hydrothorax and underwent CAPD safely. We recommend thoracoscopic surgery and pleurodesis as the first choice of therapeutic methods for pleuroperitoneal communication.
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2/24. Left-sided hepatic hydrothorax with ascites.

    hydrothorax has long been recognised as a complication of cirrhosis, but it is seen in only a few patients, mostly on the right side. We report an unusual case of massive left-sided hydrothorax complicating cirrhosis with ascites, where pleuro-peritoneal communication was demonstrated on the left side by radionuclide scanning.
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3/24. Video-assisted thoracoscopic treatment for pleuroperitoneal communication in peritoneal dialysis.

    Massive hydrothorax is an uncommon but well-recognized complication of continuous ambulatory peritoneal dialysis (CAPD). We performed a video-assisted thoracoscopic resection of the pleuro-peritoneal communication and pleurodesis in a patient with massive right hydrothorax secondary to CAPD. Histologically, the resected diaphragm was lacking in common tissue, tendons and skeletal muscle tissues, is displaced to fibrous connective tissue. These anatomic findings suggested that the cause of communication was congenital diaphragmatic change. Video-assisted thoracoscopic treatment facilitated efficient inspection and easy resection of the weak portion of the diaphragma in the case of pleuroperitoneal communication.
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4/24. Chemical pleurodesis for hepatic hydrothorax.

    BACKGROUND: ascites can occur after hepatic diseases causing dyspnea, coughing and pain. When associated with pleural effusion it can also increase respiratory distress. In a bibliographic survey hydrothorax has been observed in up to 20% of the patients and the kind of treatment is still being discussed. OBJECTIVE: This case report shows the occurrence of a large volume of ascites and pleural effusion in a cirrhotic patient and his treatment. methods: Report the case of a patient with hepatic cirrhosis due to chronic alcoholism and massive pleural effusion and ascites. He was submitted to several pleural paracenteses without success. Scintigraphy showed the presence of ascites and confirmed a possible pleuroperitoneal communication. The thoracic surgery group was called and after evaluation it was decided to submit the patient to a pulmonary decortication and chemical pleurodesis. RESULTS: These procedures were carried out with success. The pleural effusion was solved and the treatment of ascites was decided upon because the patient did not accept any surgical procedure. CONCLUSION: This treatment could be applied to patients with hydrothorax who could not be submitted to a liver transplantation.
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5/24. Systemic amyloidosis involving the diaphragm and acute massive hydrothorax during peritoneal dialysis.

    hydrothorax secondary to trans-diaphragmatic fluid leakage through a peritoneo-pleural communication is an occasional, potentially serious complication of peritoneal dialysis. The etiology of this condition is not clear, being thought to be due either to congenital or acquired diaphragmatic fenestrations or acquired scarcity of muscle fibers in the tendinous part of the diaphragm which are compounded by increased intra-abdominal pressure during the dwell period of peritoneal dialysis. We report a 54-year-old woman who developed irreversible acute renal failure from adjuvant chemotherapy for ovarian cancer previously resected surgically. Three days after the onset of continuous ambulatory peritoneal dialysis, she developed acute respiratory distress associated with a massive right hydrothorax secondary to a peritoneo-pleural communication demonstrated by scintigraphy. At autopsy 2 weeks later, systemic amyloidosis was surprisingly found and histologic examination of the right hemidiaphragm showed the presence of amyloid, among sparse muscle fibers. This is the first case report of a distinct pathological process, i.e. amyloidosis, involving the diaphragm associated with a peritoneo-pleural communication causing massive hydrothorax at the onset of peritoneal dialysis.
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6/24. Surgical treatment of massive hydrothorax complicating continuous ambulatory peritoneal dialysis.

    Acute hydrothorax is a well-recognized complication of continuous ambulatory peritoneal dialysis and is often regarded as a contraindication to its use. We report three cases treated by surgical closure of a communication between the peritoneal and pleural cavities enabling CAPD to continue successfully. This is a simple, safe and effective procedure which merits wider use as an alternative to transferring the patient to permanent hemodialysis.
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7/24. A review of management of pleuroperitoneal communication in five CAPD patients.

    Development of massive hydrothorax is well known in CAPD patients. Five CAPD patients at one center have developed some form of pleuroperitoneal communication as evidenced by pleural effusion. Temporary discontinuation of CAPD, tetracycline instillation, and surgical patch grafting of the diaphragm have been used as treatments for the communication.
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8/24. Ultrasound documentation of diaphragmatic rent in hepatic hydrothorax.

    Two patients with alcoholic cirrhosis of the liver with ascites were evaluated for the pathogenesis of right sided massive pleural effusion. The clinical course of events suggested a large communication between the peritoneal space and right pleural cavity. Real time ultrasonography revealed evidence of a tear in the right hemidiaphragm. The role of ultrasound in the documentation of cause of hydrothorax in chronic liver disease is highlighted.
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9/24. Demonstration of hydrothorax by intraperitoneal injection of technetium-99m MAA in the evaluation of peritoneovenous shunt patency.

    A case of hydrothorax in a patient with recurrent ascites following Le Veen peritoneovenous shunt placement is presented. Patency of the Le Veen shunt was studied by the intraperitoneal injection of Tc-99m MAA with subsequent activity seen in the right hemithorax only. A standard perfusion lung scan showed only the left lung to be perfused. Thus, the right hemithorax activity seen could not be due to shunt patency, but represented direct communication between the labeled ascitic fluid and the right hydrothorax seen on chest x-ray.
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10/24. Bilateral hydrothorax and hydromediastinum after a subclavian line insertion.

    A 28-year-old male patient developed bilateral hydrothorax due to extravasation of fluid into the mediastinum from a subclavian line. The injection of radio-opaque dye through the central venous cannula confirmed spillage into the mediastinum. There was no direct communication between the central venous cannula and the pleural cavities. The hydrothorax appeared to develop as a result of a shift of fluid from the mediastinum into the pleural cavities due to pressure differences in the two compartments. Bilateral chest tubes were inserted, the subclavian cannula was removed and the patient made a good recovery.
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