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Chatzigrigoriadis C, Goulioumis A, Sperdouli D, Gyftopoulos K. Embryological, anatomical and clinical considerations on pleuroperitoneal communication. Pleura Peritoneum 2023; 8:101-111. [PMID: 37662602 PMCID: PMC10469182 DOI: 10.1515/pp-2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/26/2023] [Indexed: 09/05/2023] Open
Abstract
The pleural and peritoneal cavity share many related features due to their common celomic origin. Normally these two spaces are completely separated with the development of the diaphragm. Defects in diaphragm morphogenesis may result in congenital diaphragmatic hernias, which is the most known form of communication between the pleural and peritoneal cavity. However, in several cases, findings of pleuroperitoneal communication (PPC) have been described in adults through an apparently intact diaphragm. In this comprehensive review we systematically evaluate clinical scenarios of this form of "unexpected" PPC as reported in the literature and focus on the possible mechanisms involved.
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Affiliation(s)
| | | | | | - Kostis Gyftopoulos
- Department of Anatomy, School of Medicine, University of Patras, Patras, Greece
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2
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Managing Hospitalized Peritoneal Dialysis Patients: Ten Practical Points for Non-Nephrologists. Am J Med 2021; 134:833-839. [PMID: 33737056 DOI: 10.1016/j.amjmed.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/31/2021] [Accepted: 02/06/2021] [Indexed: 01/08/2023]
Abstract
Although nephrologists are responsible for the long-term care of dialysis patients, physicians from all disciplines will potentially be involved in the management of patients with kidney failure, including patients on peritoneal dialysis, the major home-based form of kidney-replacement therapy. This review aims to fill knowledge gaps of non-experts in peritoneal dialysis and to highlight key management aspects of in-hospital care of patients on peritoneal dialysis, with a focus on acute scenarios to facilitate prompt decision-making. The clinical pearls provided should enable non-nephrologists to avoid common pitfalls in the initial assessment of peritoneal dialysis-related complications and guide their decision regarding when to refer their patients to a specialist, resulting in improved multidisciplinary patient care.
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3
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Dai BB, Lin BD, Yang LY, Wan JX, Pan YB. Novel conservative treatment for peritoneal dialysis-related hydrothorax: Two case reports. World J Clin Cases 2020; 8:6437-6443. [PMID: 33392328 PMCID: PMC7760434 DOI: 10.12998/wjcc.v8.i24.6437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patients with end-stage renal disease. PD-related hydrothorax is a rare but serious complication in PD patients, produced by the movement of peritoneal dialysate through pleuroperitoneal fistulas. In previous reports, patients with hydrothorax secondary to PD were usually recommended to discontinue PD and transfer to hemodialysis (HD). Herein, we describe another method of managing this complication—with an adjusted PD prescription and continuous drainage of pleural effusion, patients could continue PD without recurrence of hydrothorax.
CASE SUMMARY In this report, we present the medical records of 2 patients with hydrothorax secondary to PD. We recommended intermittent PD with continuous drainage of pleural effusion. A type 18Ga soft catheter was placed to drain pleural effusion. Ultrasound-guided thoracentesis was performed, and the soft catheter was placed in the pleural cavity for a long period (3 mo and 2 mo, respectively). The pleural catheter was removed when no fluid was drained from the pleural cavity. After several months, pleuroperitoneal fistulas were closed in both patients and PD was continued. These patients did not transfer to HD, had no recurrence of hydrothorax and were still treated with PD after 1 year.
CONCLUSION These 2 case reports show that continuous drainage of pleural effusion with an 18Ga soft catheter is a useful method for hydrothorax secondary to PD.
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Affiliation(s)
- Bin-Bin Dai
- Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Bei-Duo Lin
- Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Li-Yan Yang
- Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Jian-Xin Wan
- Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yang-Bin Pan
- Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
- Department of Nephrology, Shanghai Pudong Hospital, Shanghai 201399, China
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4
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Harry L, Nyakale N, Tinarwo P. Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis: A comparison with conventional diagnostic methods. Medicine (Baltimore) 2020; 99:e21029. [PMID: 32769864 PMCID: PMC7593027 DOI: 10.1097/md.0000000000021029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A pleuroperitoneal leak (PPL) is a relatively rare complication of peritoneal dialysis (PD) and early diagnosis is essential.Patients suspected of a PPL usually present with dyspnea (marked during inflow of PD fluid) and tend to have transudative high glucose pleural effusions.The PPL scintigraphy (PPLS) is one of the methods for objectively proving a PPL. The effectiveness of PPLS as a noninvasive method of evaluating a suspected PPL and its effectiveness in the exclusion of a leak in patients with similarly presenting comorbidities was assessed.Patients suspected to have a PPL were considered for PPLS based on clinical presentation and pleural fluid analysis. Radiopharmaceutical was administered into the peritoneum via the dialysis port with the patient lying supine and immediate dynamic followed by delayed statics were acquired.Of the 27 scans reviewed, 70% were found to be positive with majority detected within 12 minutes of radiopharmaceutical administration with a high predominance occurring in the right chest (P < .001). In PPLS-positive patients, when both chest X-rays and planar agreed on showing the right-sided chest predominance, the highest measurements of the pleural glucose:serum glucose ratio were recorded. A statistically significant correlation between the outcome of the scan and final decision on patient management was noted (P < .01).The PPLS is an effective diagnostic tool for assessing PPLS. However, multicenter studies investigating its added value over other conventional methods are needed to establish it as a highly relevant diagnostic tool.
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Affiliation(s)
- Lerwine Harry
- Department of Nuclear Medicine, Inkosi Albert Luthuli Hospital
| | - Nozipho Nyakale
- Department of Nuclear Medicine, Inkosi Albert Luthuli Hospital
| | - Partson Tinarwo
- Department of Biostatistics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
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5
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Tawfik A, Thomas AJ, Menias CO, Nada A, Shaaban AM, Gaballah AH, Morani AC, Jensen CT, Elsayes KM. Trans-diaphragmatic Pathologies: Anatomical Background and Spread of Disease on Cross-sectional Imaging. Curr Probl Diagn Radiol 2020; 50:252-261. [PMID: 32624297 DOI: 10.1067/j.cpradiol.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/10/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
The diaphragm is not only a sheet of muscle separating the abdominal and thoracic cavities: it plays an essential role in ventilation and can act as a gateway for the spread of different disease processes between the abdominal and the thoracic cavity. Careful attention to the appearance of the diaphragm on various imaging modalities is essential to ensure the accurate diagnosis of diaphragmatic disorders, which may be secondary to functional or anatomical derangements.
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Affiliation(s)
- Aya Tawfik
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aaron J Thomas
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Ayman Nada
- Department of Radiology, University of Missouri, Columbia, MO
| | - Akram M Shaaban
- Department of Diagnostic Radiology, University of Utah, Salt Lake City, UT
| | | | - Ajaykumar C Morani
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Corey T Jensen
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Khaled M Elsayes
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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6
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Black M, Arnold D, Mason D, Eidt J, Hohmann S. Diaphragmatic fenestrations seen after peritoneal dialysis catheter placement: A rare cause of hydrothorax. J Vasc Access 2019; 21:785-789. [PMID: 31621476 DOI: 10.1177/1129729819881015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case report summarizes the clinical course of a patient who developed diaphragmatic fenestrations leading to hydrothorax after the initiation of peritoneal dialysis. We will discuss the interesting disease process in the setting of patient presentation, diagnosis, treatment, and outcome.
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Affiliation(s)
- Matthew Black
- Department of General Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - David Arnold
- Department of General Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - David Mason
- Department of General Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - John Eidt
- Department of Vascular Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Stephen Hohmann
- Department of Vascular Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
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7
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Senthil R, Nair AVR, Pratap T, Kesavan C. Isolated Fluorodeoxyglucose Avid Right Pleural Deposits/Effusion on an F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Ovarian Cancer - Are they almost Certainly Metastatic? An Extrapolation of Atypical Meigs' Syndrome. Indian J Nucl Med 2019; 34:42-44. [PMID: 30713379 PMCID: PMC6352638 DOI: 10.4103/ijnm.ijnm_102_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Majority of ovarian cancer (OC) patients are usually diagnosed at advanced stage and present with peritoneal spread/ascites. Some patients develop pleural deposits/effusion secondary to transdiaphragmatic spread of peritoneal disease/ascites. However, pleural deposits/effusion from OC in the absence of peritoneal disease/ascites are very rare. We present a case of serous carcinoma of the left ovary with fluorodeoxyglucose (FDG) avid right pleural deposits and effusion in the absence of peritoneal disease/ascites on FDG positron emission tomography (PET)/computed tomography (CT), showing excellent response to chemotherapy in subsequent PET/CT. We also discuss the pathophysiology of pleural abnormalities in patients with ovarian diseases, a characteristic disease spread pattern and recognition of which would help in the imaging interpretation.
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Affiliation(s)
- Raja Senthil
- Department of Nuclear Medicine and PET/CT, VPS Lakeshore Hospital, Kochi, Kerala, India
| | | | - Thara Pratap
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Chitrathara Kesavan
- Department of Surgical Oncology, VPS Lakeshore Hospital, Kochi, Kerala, India
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8
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Ota T, Hasegawa Y, Okabe T, Okimura A, Fukuoka M. Porous diaphragm syndrome with recurrent thymoma. Respirol Case Rep 2019; 7:e00391. [PMID: 30519470 PMCID: PMC6261833 DOI: 10.1002/rcr2.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/10/2022] Open
Abstract
Porous diaphragm syndrome describes a defect in the diaphragm in which substances pass from the peritoneal cavity to the pleural space. Defects may be congenital or acquired. Acquired defects are caused by the thinning and eventual splitting of collagen fibres in the tendinous part of the diaphragm. We report a case of porous diaphragm syndrome with recurrent thymoma that presented with massive ascites. Increasing intra-abdominal pressure by ascites and diaphragmatic thinning due to malnutrition by malignancies resulted in the formation of an artificial hole. Thoracentesis changed the balance of hydrostatic pressure, which initiated the influx of a large volume of ascites to the pleural cavity through a hole in the diaphragm.
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Affiliation(s)
- Takayo Ota
- Department of Medical OncologyIzumi City General HospitalIzumiJapan
| | | | - Takafumi Okabe
- Department of Medical OncologyNara Hospital Kindai Faculty of MedicineIkomaJapan
| | - Akira Okimura
- Department of PathologyIzumi City General HospitalIzumiJapan
| | - Masahiro Fukuoka
- Department of Medical OncologyIzumi City General HospitalIzumiJapan
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9
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Sweet Hydrothorax. Am J Med 2018; 131:e455-e456. [PMID: 30392638 DOI: 10.1016/j.amjmed.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
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10
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Matsumura M, Mizutani E, Suzuki T, Tsurumi H, Uni R, Higashihara T, Nakahara K, Takano H. Successful Diagnosis and Treatment of Peritoneal Dialysis-Related Pleuroperitoneal Communication by Contrast-Enhanced Ultrasonography and Thoracoscopic Surgery. Perit Dial Int 2018; 37:485-486. [PMID: 28676518 DOI: 10.3747/pdi.2016.00295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- M Matsumura
- Department of Nephrology, Tokyo Teishin Hospital, Japan
| | - E Mizutani
- Department of Thoracic Surgery, Tokyo Teishin Hospital, Japan
| | - T Suzuki
- Department of Radiology, Tokyo Teishin Hospital, Japan
| | - H Tsurumi
- Department of Nephrology, Tokyo Teishin Hospital, Japan
| | - R Uni
- Department of Nephrology, Tokyo Teishin Hospital, Japan
| | - T Higashihara
- Department of Nephrology, Tokyo Teishin Hospital, Japan
| | - K Nakahara
- Department of Thoracic Surgery, Tokyo Teishin Hospital, Japan
| | - H Takano
- Department of Nephrology, Tokyo Teishin Hospital, Japan
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11
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Walker SP, Morley AJ, Stadon L, De Fonseka D, Arnold DT, Medford ARL, Maskell NA. Nonmalignant Pleural Effusions: A Prospective Study of 356 Consecutive Unselected Patients. Chest 2017; 151:1099-1105. [PMID: 28025056 DOI: 10.1016/j.chest.2016.12.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pleural effusion secondary to a nonmalignant cause can represent significant morbidity and mortality. Nonmalignant pleural effusion (NMPE) is common, with congestive heart failure representing the leading cause. Despite this, there are limited data on mortality risk and associated prognostic factors. METHODS We recruited 782 consecutive patients presenting to a pleural service between March 2008 and March 2015 with an undiagnosed pleural effusion. Further analysis was conducted in 356 patients with NMPE. Pleural biochemical analysis, cytologic analysis, thoracic ultrasonography, and chest radiography were performed. Echocardiography, CT imaging, radiologically guided biopsy, and medical thoracoscopy were undertaken as clinically indicated. Patients were followed for a minimum duration of 12 months, with the final diagnosis decided through independent review by two respiratory consultants. RESULTS Of the 782 patients, 356 were diagnosed with NMPE (46%). These patients had a mean age of 68 years (SD, 17 years) with 69% of them being men. Patients with cardiac, renal, and hepatic failure had 1-year mortality rates of 50%, 46%, and 25%, respectively. Bilateral effusions (hazard ratio [HR], 3.55; 95% CI, 2.22-5.68) and transudative effusions (HR, 2.78; 95% CI, 1.81-4.28) were associated with a worse prognosis in patients with NMPE, with a 57% and 43% 1-year mortality rate, respectively. CONCLUSIONS This is the largest prospectively collected series in patients with NMPE, demonstrating that cases secondary to organ dysfunction have extremely high 1-year mortality. In addition, the presence of bilateral and transudative effusions is an indicator of increased mortality. Clinicians should be aware of these poor prognostic features and guide management accordingly.
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Affiliation(s)
- Steven P Walker
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England.
| | - Anna J Morley
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - Louise Stadon
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - Duneesha De Fonseka
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - David T Arnold
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | | | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
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12
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Hou F, Qi X, Guo X. Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis. Dig Dis Sci 2016; 61:3321-3334. [PMID: 27456504 DOI: 10.1007/s10620-016-4260-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of HH. AIM To evaluate the effectiveness and safety of pleurodesis for HH in a systematic review with meta-analysis. METHODS All relevant papers were searched on the EMBASE and PubMed databases. As for the data from the eligible case reports, the continuous data were expressed as the median (range) and the categorical data were expressed as the frequency (percentage). As for the data from the eligible case series, the rates of complete response and complications were pooled. The proportions with 95 % confidence intervals (CIs) were calculated by using random-effect model. RESULTS Twenty case reports including 26 patients and 13 case series including 180 patients were eligible. As for the case reports, the median age was 55 years (range 7-78) and 15 patients were male. The prevalence of ascites was 76 % (19/25). Seventeen (65.38 %) patients responded favorably to pleurodesis. As for the case series, the mean age was 51.5-63.0 years and 83 patients were male. The pooled prevalence of ascites was 90 % (95 % CI 81-97 %) in 7 studies including 71 patients. The complete response rate after pleurodesis was reported in all studies, and the pooled rate was 72 % (95 % CI 65-79 %). Complications related to pleurodesis were reported in 6 studies including 63 patients, and the pooled rate was 82 % (95 % CI 66-94 %). CONCLUSION Pleurodesis may be a promising treatment for HH, but carries a high rate of complications.
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Affiliation(s)
- Feifei Hou
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China.
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China.
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13
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Binmahfouz AS, Steinke K. The wanderlust of a gallstone: a case report of intrathoracic migration of a gallstone post complicated cholecystectomy mimicking lung cancer. BJR Case Rep 2016; 2:20150430. [PMID: 30460026 PMCID: PMC6243302 DOI: 10.1259/bjrcr.20150430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/04/2016] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
Gallstones migrating into the right hemithorax post complicated cholecystectomy may be misdiagnosed for lung cancer, especially in the context of a distant history of cholecystectomy, poor recall of medical history and incomplete patient data. We present a case of a female patient with heavy smoking history who presented to our emergency department with haemoptysis and mild weight loss. Imaging workup showed an 18F-fludeoxyglucose positron emission tomography-positive heterogeneous nodule with central calcification in the right lower lobe, carrying lung cancer as a differential diagnosis. The resected specimen revealed an inflammatory pseudomass formed around a gallstone. This case illustrates the importance of knowing the spectrum of clinical and radiological presentation of a gallstone migrating into the right hemithorax, in order to prompt appropriate management and prevent misdiagnosis and mistreatment.
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14
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Ratajczak A, Lange-Ratajczak M, Bobkiewicz A, Studniarek A. Surgical Management of Complications with Peritoneal Dialysis. Semin Dial 2016; 30:63-68. [PMID: 27596540 DOI: 10.1111/sdi.12538] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This report reviews the most common surgical interventions and complications of chronic peritoneal dialysis (PD) patients. Based on the current knowledge as well as our experience we detail the role of these surgical procedures. We supplement the reported knowledge in the field with our own experience in this area. The areas discussed include early complications such as surgical wound hemorrhage, bleeding from the catheter, intestinal perforation and urinary bladder perforation, dialysate leakage through the wound, as well as late complications including catheter kinking or occlusion, retention of fluid in the peritoneal recess, hernias and hydrothorax, and encapsulating peritoneal sclerosis. We also briefly cover the surgical aspects of exit-site infection and peritonitis. An understanding by nephrologists of the role for surgical intervention in PD patients will improve their care and outcomes.
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Affiliation(s)
- Andrzej Ratajczak
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Lange-Ratajczak
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Studniarek
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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15
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Deal A, Evans D, Counselman FL. Tension Hydrothorax from Disseminated Endometriosis. West J Emerg Med 2016; 17:88-90. [PMID: 26823940 PMCID: PMC4729429 DOI: 10.5811/westjem.2015.11.28503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/13/2015] [Accepted: 11/13/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- AnnaKate Deal
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - David Evans
- Virgina Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Francis L Counselman
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia; Emergency Physicians of Tidewater, Norfolk, Virginia
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16
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Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports of Three Ovarian Tumors Presenting with Massive Ascites, but without Peritoneal Dissemination. Case Rep Obstet Gynecol 2015; 2015:414019. [PMID: 26858849 PMCID: PMC4697079 DOI: 10.1155/2015/414019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/06/2015] [Accepted: 10/18/2015] [Indexed: 12/15/2022] Open
Abstract
Borderline ovarian tumors are benign but relatively large tumors that are often initially mistaken as ovarian cancers. We report three cases of stage I borderline ovarian tumors having massive ascites that we (preoperatively) suspected of being advanced ovarian cancer. The three patients (35, 47, and 73 years old) reported feeling fullness of the abdomen before consulting their gynecologist. By CT scan, they were diagnosed with a pelvic tumor accompanied by massive ascites, the diameters of which were 11, 20, and 11 cm, respectively. Postsurgical pathology showed all were stage I borderline ovarian tumors without dissemination; two were mucinous and one was serous. The amount of ascites was 6,300, 2,600, and 3,600 mL, respectively, and was serous in all. Cytodiagnosis of the ascites found that one was positive for tumor cells and two were negative. After resection of the mass, the ascites disappeared in all three cases. No pleural effusion was present at any time. The literature is reviewed concerning ascites and pleural effusions linked to ovarian tumors, and a supposition is forwarded of why pleural effusion presents sporadically in these cases.
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