Subarachnoid-pleural fistula: To drain or not to drain

E Moncomble; S Al Kahf; S Clerc; L Ikka; G Lonjon; B Planquette

doi:10.1016/j.resmer.2020.100786

Subarachnoid-pleural fistula: To drain or not to drain

Respir Med Res. 2021 Nov:80:100786. doi: 10.1016/j.resmer.2020.100786. Epub 2020 Aug 26.

Authors

E Moncomble¹, S Al Kahf¹, S Clerc², L Ikka³, G Lonjon⁴, B Planquette⁵

Affiliations

¹ Service de pneumologie et de soins intensifs, hôpital Européen Georges-Pompidou, AP-HP, Paris, France.
² Service de pneumologie et de soins intensifs, hôpital Européen Georges-Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France.
³ Service de neuroradiologie interventionnelle, hôpital Bicêtre, AP-HP, Paris, France.
⁴ Service d'orthopédie et de traumatologie, hôpital Européen Georges-Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France.
⁵ Service de pneumologie et de soins intensifs, hôpital Européen Georges-Pompidou, AP-HP, Paris, France; Université de Paris, Paris, France; Inserm UMRS 11400, Paris, France. Electronic address: benjamin.planquette@aphp.fr.

PMID: 34237481
DOI: 10.1016/j.resmer.2020.100786

Abstract

Subarachnoid-pleural fistula (SPF) is a rare complication of spine surgery with a transthoracic approach. The outcome of such an injury is affected by not only the pulmonary status due to the pleural effusion but also the neurological one, secondary to the intracranial hypotension. After reviewing the few published cases of SPF, the journey to diagnosis seams heterogenous and the management plan non-uniform. We report the case of a 48-year old women who underwent a right transthoracic discectomy that was complicated by an SPF. The diagnosis, although suspected perioperatively, was established with the gathering of an abundant post-operative pleural effusion, a subdural hematoma on head Computerized Tomography after drainage and Cerebro-Spinal Fluid markers present in the pleural fluid. The defect was effectively corrected with a radiological procedure. We compare our clinical and paraclinical findings and management plans to those reported in the few other published cases of SPF.

Keywords: Beta trace protein; Discectomy; Pleural draina; Subarachoid-pleural fistula.

Publication types

Case Reports

MeSH terms

Drainage
Female
Fistula* / diagnostic imaging
Fistula* / etiology
Humans
Middle Aged
Pleural Diseases* / diagnosis
Pleural Diseases* / etiology
Pleural Diseases* / surgery
Pleural Effusion* / diagnostic imaging
Pleural Effusion* / etiology
Subarachnoid Space / diagnostic imaging