Left-sided hydrothorax in connection with severe pre-eclampsia. Case reports

Four cases of left-sided pleural hydrothorax in connection with severe pre-eclampsia are reported. In addition an increased formation of ascitic fluid was observed in the patients. A long-lasting bed rest in the left lateral recumbent position preceded the discovery of the roentgenologically verified pleural changes. Hypoproteinemia caused by the excretion of large amounts of protein in the urine seems to be a partial etiological factor aggravated by the renal retention of sodium and water. Pleural transudate disappeared spontaneously within two weeks from the delivery. In such cases, immediate diagnostic procedures, e.g. the exclusion of tuberculosis, are unnecessary. The authors think that the phenomenon is common in similar cases but usually remains undiagnosed.

Postoperative malignant seroma: CT demonstration of its formation mechanism

A malignant seroma in the subscapular region of the chest wall developed postoperatively in a 51-year-old man with a malignant right pleural mesothelioma treated with extrapleural pneumonectomy. Computed tomography revealed the direct communication of the seroma with the hydrothorax. Correlation of CT and pathologic findings is made and the mechanism for the development of such a malignant seroma is proposed.

Total intravenous hyperalimentation (TIH) complications in childhood: a radiological survey

Sixty consecutive patients, except for one 7-year-old patient, their ages varying from 1 day to 12 months received total intravenous hyperalimentation (TIH). It was possible to observe non-pathological catheter malpositions and, in 14 patients, other complications. The most serious complications observed included the following: thrombus and pericatheter thrombus calcification; superior vena cava thrombotic occlusion; hydrothorax; mediastinal effusion; generalized septic arthritis; venous transfixion with flooding of the soft tissues of the neck; vein wall lesions; collateral vertebral circulation; and a catheter tip blocked in vein. A brief comment is given on the use of this procedure and what may happen.

Hydromediastinum and hydrothorax in the neonate with central vein catheterization

A near fatal complication of central venous catheterization in a newborn infant is reported. Five days after insertion, the catheter tip eroded through the wall of the vein, causing hydromediastinum and hydrothorax with acute circulatory and respiratory distress. The diagnosis was confirmed by noting that the tip of the catheter had become curved downwards, by aspirating slightly bloodstained fluid from the pleural space and by injecting radio-opaque dye through the catheter. Recovery followed removal of the catheter, intercostal drainage, intubation and positive pressure respiration. The erosion of the vein may have been brought about by the location of the catheter tip at the junction of the left subclavian and innominate veins--a less than optimal position. The factors causing this complication are discussed. Recommendations are made about the type of catheter, its appropriate placement and maintenance. The diagnosis and management are surveyed.

[Traumatic rupture of the diaphragm - a problem of radiological diagnosis (author's transl)]

Traumatic ruptures of the diaphragm are frequently missed, resulting in a delayed diagnosis. Six patients with this entity are presented and the literature is reviewed. Several radiological findings which are easily overlooked, are described. The so-called pseudodiaphragm effect, due to herniated bowel or stomach and mimicking an elevated diaphragmatic leaflet, is emphasized.

Technetium-99m-labelled macroaggregated albumin in demonstration of trans-diaphragmatic leakage of dialysate in peritoneal dialysis

A patient developed a right pleural effusion soon after starting a program of continuous ambulatory peritoneal dialysis. The etiology of the effusion was unclear. 99mTc-labelled macroaggregated albumin was administered intraperitoneally, followed by 2 liters of dialysate. Trans-diaphragmatic leakage was clearly demonstrated, and confirmed by high count rates of pleural fluid with negligible blood count. This method can safely be used to demonstrate trans-diaphragmatic fluid leakage in peritoneal dialysis patients.

Tension hydrothorax: roentgenographic characteristics and pathogenetic consideration

We have described a 24-year-old diabetic woman with rapidly developing left-sided tension hydrothorax. The pleural effusion was characterized by high contents of protein and glucose. The chest roentgenogram exhibited massive pleural effusion, prominent air bronchograms, mediastinal shift, and diaphragmatic inversion. Prompt thoracocentesis proved to be life-saving.

Unilateral hydrothorax secondary to ascites demonstration by a noninvasive radionuclide imaging technique

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Persistent hepatic hydrothorax after peritoneojugular shunt

Hepatic hydrothorax causes serious respiratory morbidity and is difficult to cure. Evacuation of ascites via peritoneojugular shunt should eliminate the source of the pleural fluid. However, this technique is not infallible. Obtaining pleurodesis by chemical or mechanical means may be necessary. Two cases were successfully treated with pleurectomy and tube thoracostomy, respectively.

Hydrothorax with peritoneal dialysis: radionuclide detection of a pleuro-peritoneal connection

Unilateral hydrothorax occurring during peritoneal dialysis is well described and has been presumed to be secondary to a pleuroperitoneal communication. Diagnosis of these communications usually requires invasive procedures. A non-invasive method of confirmation of abnormal pleuro-peritoneal communication using radionuclide scanning is outlined. The occurrence of this complication has usually meant cessation of this type of dialysis. However, this patient illustrates that continuation of peritoneal dialysis is possible.

Hemothorax in the newborn

Twenty cases of hemothorax in newborns, including 4 of our own patients, are reviewed in detail. This unusual cause of acute respiratory distress within the neonatal period was observed in 14 males and 6 females. Most of the patients were fullterm newborns. As causal factors hemorrhagic disease of the newborn (vitamin K deficiency), disseminated intravascular coagulation, arteriovenous malformations and pleural/vascular rupture are considered. The time of occurrence of bleeding symptoms ranged from 1 to 28 days of life. Sixteen out of 20 patients survived without sequelae, but in 4 cases the outcome was lethal.

Acute massive hydrothorax complicating peritoneal dialysis, report of 2 cases and a review of the literature

Acute massive right-sided hydrothorax is a relatively rare but serious complication of peritoneal dialysis and may be responsible for the development of dyspnea during peritoneal dialysis. The pleural fluid appears to arise from the peritoneal dialyzate based on the time of its appearance and its chemical composition. It should be included in the differential diagnosis when a patient becomes dyspneic during peritoneal dialysis along with exaccerbation of congestive heart failure, pneumonia, atelectasis, and purulent bronchitis. Its occurrence is an indication to stop the peritoneal dialysis and contraindicates further use of this form of dialysis. Treatment may be conservative or aggressive (thoracentesis) depending on the clinical condition of the patient. Etiology is poorly understood. In some cases, there may be traumatic diaphragmatic fenestrations, but the majority of cases appear to be due to less well defined communications between the peritoneal and pleural spaces.

[Hydrothorax during the neonatal period (author's transl)]

The congenital hydrothorax is a rare cause of the RDS in the newborn. Our observations on three patients with bilateral pleural effusions and 44 cases from the literature will be discussed; we emphasize the importance of this serious disease in the newborn period. The pathogenesis is largely unknown, however, its possible etiology like birth trauma or dysplasia of the lymphatic system are discussed. It should be pointed out that this condition can be rapidly recognized by radiographic examination and successfully treated. The reported survival rate is 29 out of 44 (66%).

Primary pulmonary hypoplasia: report of a case with polyhydramnios

We describe a case of extreme primary pulmonary hypoplasia. No other congenital anomalies and none of the conditions known to be associated with pulmonary hypoplasia were present. Pregnancy had been complicated by substantial polyhydramnios. The hypoplasia was due to a marked deficiency of the respiratory parenchyma in the presence of normal upper airways and bronchi. Virtually no parenchymal development had occurred and there were very few bronchioles, alveolar ducts, and alveoli. The changes differ from those seen in pulmonary hypoplasia secondary to congenital diaphragmatic hernia, bilateral renal agenesis, anomalies of the urinary outflow tracts, and malformations of the thoracic cavity, in which the pulmonary hypoplasia appears to be compressive in nature. While neither the etiology or pathogenesis of the pulmonary hypoplasia are apparent in this case, the presence of substantial polyhydramnios during pregnancy suggests the possibility that the developing lungs may offer an important surface area for reabsorption and recycling of constituents of amniotic fluid.

Hydrothorax: unusual complication of ventriculoperitoneal shunts

A case is presented in which puncture of the pleura and hydrothorax occurred during placement of a ventriculoperitoneal shunt. Treatment of this complication is outlined.

Transient asymptomatic hydrothorax in pregnancy at term

Two cases of transient asymptomatic hydrothorax during pregnancy are reported. In both cases the effusions resolved completely within a week of the termination of pregnancy. No apparent pathologic explanation could be found for this finding.