Frédéric V Valla1. 1. Pediatric Intensive Care Unit, Debrousse Pediatric University Hospital, Lyon, France. frederic.valla@chu-lyon.fr
Abstract
OBJECTIVE: To report a pediatric case of subarachnoid-pleural fistula, its diagnosis, and its treatment. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 9-month-old boy, presenting with severe pleural effusion after posterior chest wall surgery. INTERVENTIONS: Subarachnoid-pleural fistula was confirmed by isolating beta2-transferrin in the pleural fluid and with magnetic resonance cisternography revealing the location. The patient had a healthy outcome, and the fistula dried without surgery, using positive-pressure ventilation and a chest drain. CONCLUSIONS: We used beta2-transferrin to confirm the diagnosis of clinically suspected subarachnoid-pleural fistula. High-resolution computed tomographic and magnetic resonance cisternography are the best techniques to localize the fistula. The currently recommended treatment is surgery; we suggest that bilevel positive-pressure ventilation, especially with noninvasive techniques, could be a treatment alternative, reducing the flow of cerebral spinal fluid through the fistula and allowing spontaneous closure.
OBJECTIVE: To report a pediatric case of subarachnoid-pleural fistula, its diagnosis, and its treatment. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 9-month-old boy, presenting with severe pleural effusion after posterior chest wall surgery. INTERVENTIONS:Subarachnoid-pleural fistula was confirmed by isolating beta2-transferrin in the pleural fluid and with magnetic resonance cisternography revealing the location. The patient had a healthy outcome, and the fistula dried without surgery, using positive-pressure ventilation and a chest drain. CONCLUSIONS: We used beta2-transferrin to confirm the diagnosis of clinically suspected subarachnoid-pleural fistula. High-resolution computed tomographic and magnetic resonance cisternography are the best techniques to localize the fistula. The currently recommended treatment is surgery; we suggest that bilevel positive-pressure ventilation, especially with noninvasive techniques, could be a treatment alternative, reducing the flow of cerebral spinal fluid through the fistula and allowing spontaneous closure.