Hydrothorax with alveolar-pleural fistula mimicking re-expansion pulmonary edema during liver transplantation: a case report.
10.4097/kjae.2015.68.2.184
- Author:
Jae Hee WOO
1
;
Rack Kyung CHUNG
;
Hee Jung BAIK
;
Youn Jin KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea. rkchung@ewha.ac.kr
- Publication Type:Case Report
- Keywords:
Fistula;
Hydrothorax;
Liver transplantation
- MeSH:
Diagnosis, Differential;
Drainage;
Exudates and Transudates;
Fistula*;
Humans;
Hydrothorax*;
Liver Transplantation*;
Lung;
Pleural Effusion;
Positive-Pressure Respiration;
Pulmonary Edema*;
Ventilation
- From:Korean Journal of Anesthesiology
2015;68(2):184-187
- CountryRepublic of Korea
- Language:English
-
Abstract:
We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation, which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotracheal tube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosed with an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmatic incision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusion towards the ipsilateral lung during the remaining operation period. Surgeon repaired the defect on the exposed lung surface via diaphragmatic opening. Anesthesiologists should consider an alveolar-pleural fistula as a possible differential diagnosis with re-expansion pulmonary edema when transudate emanating from the endotracheal tube is obtained in patients with massive hydrothorax.
