1.Integration of simulated thoracentesis using Thiel-preserved cadavers in the teaching of thoracic anatomy for learning unit III medical students: An innovative learning strategy.
Abdel Jeffri A. ABDULLA ; Ronnie E. BATICULON ; Rowena F. GENUINO ; Cindy Pearl J. SOTALBO ; Jose V. TECSON III
Acta Medica Philippina 2025;59(6):33-39
BACKGROUND
Proficiency in performing thoracentesis is a key competency recommended in the Medical Schools Objective Project (MSOP) adopted by the American Association of Medical Colleges, USA, that medical students should possess prior to graduation, although they often do not practice it clinically until the later stages of their training. Thiel-embalmed cadavers, which offer a lifelike experience with less irritation than formalin-preserved cadavers, have been increasingly used as early as 1st year medical school to teach such procedures because of their feel-like and look-like real patients. There are no studies on the use of Thiel- cadavers for simulated thoracentesis among medical students in the Philippines.
OBJECTIVETo evaluate the attitudes and perceptions of medical students on the use of Thiel-soft embalmed cadavers for simulated thoracentesis as to the understanding of thoracic anatomy, overall learning experience, and confidence in performing the procedure in the cadaver and possibly in the clinical setting.
METHODSThis is a descriptive cross-sectional study among Learning Unit III medical students in the University of the Philippines conducted from June 13 to 17, 2022. In the final station of the Organ System Course 205 of the Department of Anatomy's LEAP II program, a simulated thoracentesis procedure was set up using a Thiel-preserved cadaver with artificially created pleural effusion. After watching and studying thoracic anatomy, watching a video on how thoracentesis was performed by a general surgeon, students performed the procedure, and were asked to answer a 6-question Likert-scale survey to assess their perceptions and attitudes of the simulation procedure. Data was analyzed using descriptive statistics.
RESULTSMost of the students strongly agreed that practicing thoracentesis on the soft cadaver has improved their understanding of the anatomical basis of doing thoracentesis (97%) and of the steps of the procedure (94.9%). Similarly, when asked about how they felt doing the simulated thoracentesis, almost all (98%) strongly agreed that it was an enjoyable and stimulating learning experience. Majority strongly agreed (68%) that they felt capable doing the procedure on a soft cadaver against less than half (38.4%) feeling capable of doing it in the clinical setting. Almost all (97%) strongly agreed that simulated thoracentesis on a soft-embalmed cadaver should be part of the learning competencies of medical students because of the skills they learn by doing the procedure.
CONCLUSIONIntegrating a simulated thoracentesis using a Thiel-preserved cadaver early in the course of a student’s medical education, provided students with a better understanding of the anatomy of the thoracic wall and the anatomical basis of doing this simulation procedure. Though confidence in performing the procedure in a soft cadaver is higher than in a clinical setting, the latter setting may need repeated training to further hone their skills. Practicing thoracentesis on soft-embalmed cadavers significantly enhanced medical students' understanding and enjoyment of the procedure. This innovative approach can be considered by anatomy educators as an integrative learning activity when teaching thoracic cage anatomy. This can also be extended to senior medical students and residents across different specialties.
Human ; Thoracentesis ; Education, Medical
2.Contarini’s syndrome in a COVID-19 positive patient with viral myocarditis and diabetic ketoacidosis: A case report
Ria Katrina B. Cortez ; Charlie A. Clarion ; Albert Mitchell L. Yap ; Ma. Kriselda Karlene G. Tan
Acta Medica Philippina 2024;58(Early Access 2024):1-5
:
Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion.
:
This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP.
This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.
Pleural effusion
;
Thoracentesis
;
COVID-19
3.A Prospective Randomized Trial Comparing Manual Needle Aspiration to Closed Thoracostomy as an Initial Treatment for the First Episode of Primary Spontaneous Pneumothorax
In Ha KIM ; Do Kyun KANG ; Ho Ki MIN ; Youn Ho HWANG
The Korean Journal of Thoracic and Cardiovascular Surgery 2019;52(2):85-90
BACKGROUND: Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. METHODS: This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. RESULTS: Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was 2.1±1.8 days and 5.4±3.6 days, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. CONCLUSION: Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.
Comorbidity
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Consensus
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Humans
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Length of Stay
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Lung Diseases
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Needles
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Pneumothorax
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Pregnancy
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Prospective Studies
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Recurrence
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Thoracentesis
;
Thoracostomy
4.Ultrasonographic quantification of pleural effusion: comparison of four formulae.
Bolanle Olubunmi IBITOYE ; Bukunmi Michael IDOWU ; Akinwumi Babatunde OGUNROMBI ; Babalola Ishmael AFOLABI
Ultrasonography 2018;37(3):254-260
PURPOSE: The purpose of this study was to evaluate the correlations of ultrasonographically estimated volumes of pleural fluid with the actual effusion volume in order to determine the most reliable formula. METHODS: In 32 consecutive patients with clinically diagnosed pleural effusion, an ultrasound estimation was made of the volume of effusion using four different formulae, including two in the erect position and two in the supine position. Closed-tube thoracostomy drainage using a 28-Fr chest tube was performed. The total drainage was calculated after confirmation of full lung re-expansion and complete drainage by plain chest radiographs and ultrasound. The ultrasonographically estimated volume was compared to the actual total volume drained as the gold standard. RESULTS: There were 14 female and 18 male subjects. The mean age of all subjects was 41.56±18.34 years. Fifty percent of the effusions were in the left hemithorax. Metastatic disease accounted for the plurality of effusions (31.2%). The mean total volume drained for all the subjects was 2,770±1,841 mL. The ultrasonographically estimated volumes for the erect 1, erect 2, supine 1, and supine 2 formulae were 1,816±753 mL, 1,520±690 mL, 2,491±1,855 mL, and 1,393±787 mL, respectively. The Pearson correlation coefficients (r) for the estimate of each formula were 0.75, 0.81, 0.62, and 0.63, respectively. CONCLUSION: Although both erect formulae showed similar correlations, the erect 2 formula (Goecke 2) was most closely correlated with the actual volume drained.
Chest Tubes
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Drainage
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Female
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Humans
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Lung
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Male
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Pleural Effusion*
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Radiography, Thoracic
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Supine Position
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Thoracentesis
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Thoracostomy
;
Ultrasonography
5.Spontaneous pneumothorax in two dogs undergoing combined laparoscopic ovariectomy and total laparoscopic gastropexy
Cristiano BENDINELLI ; Fabio LEONARDI ; Roberto PROPERZI
Journal of Veterinary Science 2019;20(3):e25-
Two dogs underwent a combined laparoscopic ovariectomy and total laparoscopic gastropexy. The intra-abdominal pressure and pulmonary compliance decreased, but the peak airway pressure increased at 20 min after the start of gastropexy with intracorporeal suturing. Right chest auscultation and percussion revealed reduced breath sounds and hyper-resonance. No abnormalities in the functioning of the instruments or diaphragmatic defects were detected. The tidal volume was reduced and a positive end-expiratory pressure of 5 cmH₂O was applied. The right chest of the two dogs was drained off: 950 mL (case 1) and 250 mL (case 2) of gas. After thoracentesis, the pulmonary compliance improved and surgery was completed successfully. The postoperative chest radiographs highlighted the residual right pneumothorax.
Animals
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Auscultation
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Compliance
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Dogs
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Female
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Gastropexy
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Laparoscopy
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Ovariectomy
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Percussion
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Pneumothorax
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Positive-Pressure Respiration
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Radiography, Thoracic
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Thoracentesis
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Thorax
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Tidal Volume
6.Disappearance of pericardial effusion by suspected pericardial-pleural fistulain a Miniature Schnauzer dog
Hakhyun KIM ; Ji Houn KANG ; Dongwoo CHANG
Korean Journal of Veterinary Research 2018;58(2):115-118
A 13-year-old spayed female Miniature Schnauzer was presented with complaints of intermittent syncope. Pericardial effusion was confirmed based on the physical examination, thoracic radiographs and echocardiography. Subsequently, prompt pericardiocentesis was performed. Clinical abnormalities were immediately improved after pericardiocentesis. However, the clinical signs associated with acute collapse recurred. After the second pericardiocentesis, thoracic radiographs revealed pleural effusion, and the clinical signs resolved rapidly. The dog underwent pleural aspiration. Analysis of pleural fluid revealed almost similar features as the previous pericardial fluid. It was possible that a pericardial-pleural fistula was created during the pericardiocentesis. The pericardial and pleural effusion disappeared after the procedures.
Adolescent
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Animals
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Cardiac Tamponade
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Dogs
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Echocardiography
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Female
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Fistula
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Humans
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Pericardial Effusion
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Pericardial Fluid
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Pericardiocentesis
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Physical Examination
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Pleural Effusion
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Syncope
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Thoracentesis
7.Corticosteroid Therapy for Refractory Uremic Pleurisy.
Eun Ji PARK ; Min A PARK ; Myung Jae PARK ; So Young PARK ; Seung Hyeun LEE
The Ewha Medical Journal 2016;39(4):125-128
Uremic pleuritis is a fibrinous pleuritis of unknown pathogenesis in patients with chronic kidney disease. Although it responds to regular dialysis or repeated thoracentesis, cases that are refractory to those therapies have been reported. We report a case of uremic pleuritis which showed marked improvement following corticosteroid therapy. The effusion was exudate, and negative in cytology and microbiology. Pleural biopsy revealed chronic inflammation with fibrosis. The pleural effusion did not respond to chest tube drainage and continuance of hemodialysis. With a diagnosis of refractory uremic pleuritis, we started methylprednisolone. The pleural effusion responded to the treatment and resolved without complication.
Biopsy
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Chest Tubes
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Diagnosis
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Dialysis
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Drainage
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Exudates and Transudates
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Fibrin
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Fibrosis
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Humans
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Inflammation
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Methylprednisolone
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Pleural Effusion
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Pleurisy*
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Renal Dialysis
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Renal Insufficiency, Chronic
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Thoracentesis
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Uremia
8.Peripheral T-cell Lymphoma Presenting with Chylothorax.
Seong Taeg KIM ; Jaemin JO ; Jeong Rae YOO ; Miyeon KIM ; Kyoung Hee HAN ; Jung Ho KIM ; Sang Hoon HAN
Korean Journal of Medicine 2017;92(1):74-78
A 72-year-old male presented with respiratory discomfort. A simple chest X-ray and abdominal computed tomography showed pleural effusion and multiple lymph node enlargement. The pleural effusion was determined by thoracentesis to be chylothorax. An inguinal lymph node biopsy showed peripheral T-cell lymphoma. Following three cycles of cyclophospamide, hydroxyl doxorubicin, vincristine, prednisolone (CHOP) chemotherapy, a partial response was observed. Chylothorax is an extremely rare complication of T-cell lymphoma. We present a case of peripheral T-cell lymphoma presenting with chylothorax. We suggest that clinicians should consider chylothorax when examining patients with lymphoma who present with atypical pleural effusion.
Aged
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Biopsy
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Chylothorax*
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Doxorubicin
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Drug Therapy
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Humans
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Lymph Nodes
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Lymphoma
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Lymphoma, T-Cell
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Lymphoma, T-Cell, Peripheral*
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Male
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Pleural Effusion
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Prednisolone
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Thoracentesis
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Thorax
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Vincristine
9.Various Treatment Modalities in Hepatic Hydrothorax: What Is Safe and Effective?
Jae Hyun YOON ; Hee Joon KIM ; Chung Hwan JUN ; Sung Bum CHO ; Yochun JUNG ; Sung Kyu CHOI
Yonsei Medical Journal 2019;60(10):944-951
PURPOSE: Hepatic hydrothorax is a complication of decompensated liver cirrhosis that is difficult and complex to manage. Data concerning the optimal treatment method, other than liver transplantation, are limited. This study aimed to compare the clinical features and outcomes of patients treated with various modalities, while focusing on surgical management and pigtail drainage. MATERIALS AND METHODS: Forty-one patients diagnosed with refractory hepatic hydrothorax between January 2013 and December 2017 were enrolled. RESULTS: The mean Child-Turcotte-Pugh and model for end stage liver disease scores of the enrolled patients were 10.1 and 19.7, respectively. The patients underwent four modalities: serial thoracentesis (n=11, 26.8%), pigtail drainage (n=16, 39.0%), surgery (n=10, 24.4%), and liver transplantation (n=4, 9.8%); 12-month mortality rate/median survival duration was 18.2%/868 days, 87.5%/79 days, 70%/179 days, and 0%/601.5 days, respectively. Regarding the management of refractory hepatic hydrothorax, surgery group required less frequent needle puncture (23.5 times in pigtail group vs. 9.3 times in surgery group), had a lower occurrence of hepatorenal syndrome (50% vs. 30%), and had a non-inferior cumulative overall survival (402.1 days vs. 221.7 days) compared to pigtail group. On multivariate analysis for poor survival, body mass index <19 kg/m², refractory hepatic hydrothorax not managed with liver transplantation, Child-Turcotte-Pugh score >10, and history of severe encephalopathy (grade >2) were associated with poor survival. CONCLUSION: Serial thoracentesis may be recommended for management of hepatic hydrothorax and surgical management can be a useful option in patients with refractory hepatic hydrothorax, alternative to pigtail drainage.
Body Mass Index
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Brain Diseases
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Drainage
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End Stage Liver Disease
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Fibrosis
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Hepatorenal Syndrome
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Humans
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Hydrothorax
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Liver Cirrhosis
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Liver Transplantation
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Methods
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Mortality
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Multivariate Analysis
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Needles
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Punctures
;
Thoracentesis
10.A Rare Case of Unilateral Pleural Effusion in a Pediatric Patient on Chronic Peritoneal Dialysis: Is it a Pleuroperitoneal Leakage?
Sukdong YOO ; Jae Yeon HWANG ; Ji Yeon SONG ; Taek Jin LIM ; Narae LEE ; Su Young KIM ; Seong Heon KIM
Childhood Kidney Diseases 2018;22(2):86-90
Non-infectious complications of peritoneal dialysis (PD) are relatively less common than infectious complications but are a potentially serious problem in patients on chronic PD. Here, we present a case of a non-infectious complication of PD in a 13-year-old boy on chronic PD who presented with symptoms such as hypertension, edema, dyspnea, and decreased ultrafiltration. Chest and abdominal radiography showed pleural effusion and migration of the PD catheter tip. Laparoscopic PD catheter reposition was performed because PD catheter malfunction was suspected. However, pleural effusion relapsed whenever the dialysate volume increased. To identify peritoneal leakage, computed tomography (CT) peritoneography was performed, and a defect of the peritoneum in the left lower abdomen with contrast leakage to the left rectus and abdominis muscles was observed. He was treated conservatively by transiently decreasing the volume of night intermittent PD and gradually increasing the volume. At the 2-year follow-up visit, the patient had not experienced similar symptoms. Patients on PD who present with refractory or recurrent pleural effusion that does not respond to therapy should be assessed for the presence of infection, catheter malfunction, and pleuroperitoneal communication. Thoracentesis and CT peritoneography are useful for evaluating pleural effusion, and timely examination is important for identifying the defect or fistula.
Abdomen
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Adolescent
;
Catheters
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Dyspnea
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Edema
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Fistula
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Follow-Up Studies
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Humans
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Hypertension
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Male
;
Muscles
;
Peritoneal Dialysis
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Peritoneum
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Pleural Effusion
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Radiography, Abdominal
;
Thoracentesis
;
Thorax
;
Ultrafiltration