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Subarachnoidal-pleural fistula (SAPF) as an unusual cause of persistent pleural effusion: beta-trace protein as a marker for SAPF: case report and review of the literature

(2015) ACTA CLINICA BELGICA. 70(1). p.53-57
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Abstract
Background: We describe a case of a 56-year-old woman who developed a recurrent pleural effusion after a thoracoscopic resection of an anterior bulging thoracic disc hernia (level D9-D10). Despite several evacuating pleural punctions, dyspnea reoccurred due to recurrent pleural effusion, the same side as the disc resection. Because of increasing headache after each punction, a subarachnoidal pleural fistula (SAPF) was suspected. Although magnetic resonance imaging (MRI) showed features suggestive of SAPF, there was not enough evidence to justify a new thorascopy. Methods: Cerebrospinal fluid (CSF) leakage into the thoracic and abdominal cavity has been described as a result of trauma or surgery. Detection of beta-trace protein (BTP, a brain-specific protein) has been described to detect CSF fistulae causing rhino- and otoliquorrhea. Similarly, BTP determination could be used to identify the presence of CSF at other anatomical sites such as the thoracic cavity. Therefore, we decided to determine the concentration of BTP in the pleural effusion of this patient. BTP was assayed using immunonephelometry. Results: The patient's BTP pleural fluid concentration was 14·0 mg/l, which was a 25-fold increase compared with the BTP serum concentration. After insertion of a subarachnoidal lumbal catheter, a video-assisted thorascopy was performed. Leakage of liquor through the parietal pleura into the thoracic cavity was observed. The SAPF was closed using a durasis patch and DuraSeal®. Postoperatively, there was no reoccurrence of pleural fluid. Conclusions: SAPF has to be included to the differential diagnosis of patients with persistent pleural effusion after spinal surgery. This case illustrates the importance of BTP in diagnosing SAPF, especially in cases where major therapeutic consequences may need to be drawn.
Keywords
CSF leakage, CEREBROSPINAL-FLUID LEAKS, Beta-trace protein, COMPLICATION, Pleural effusion, Subarachnoid pleural fistula

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Citation

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Chicago
DESEYNE, SARAH, Karlien Vanhouteghem, GIORGIO HALLAERT, Joris Delanghe, and Thomas Malfait. 2015. “Subarachnoidal-pleural Fistula (SAPF) as an Unusual Cause of Persistent Pleural Effusion: Beta-trace Protein as a Marker for SAPF: Case Report and Review of the Literature.” Acta Clinica Belgica 70 (1): 53–57.
APA
DESEYNE, S., Vanhouteghem, K., HALLAERT, G., Delanghe, J., & Malfait, T. (2015). Subarachnoidal-pleural fistula (SAPF) as an unusual cause of persistent pleural effusion: beta-trace protein as a marker for SAPF: case report and review of the literature. ACTA CLINICA BELGICA, 70(1), 53–57.
Vancouver
1.
DESEYNE S, Vanhouteghem K, HALLAERT G, Delanghe J, Malfait T. Subarachnoidal-pleural fistula (SAPF) as an unusual cause of persistent pleural effusion: beta-trace protein as a marker for SAPF: case report and review of the literature. ACTA CLINICA BELGICA. 2015;70(1):53–7.
MLA
DESEYNE, SARAH, Karlien Vanhouteghem, GIORGIO HALLAERT, et al. “Subarachnoidal-pleural Fistula (SAPF) as an Unusual Cause of Persistent Pleural Effusion: Beta-trace Protein as a Marker for SAPF: Case Report and Review of the Literature.” ACTA CLINICA BELGICA 70.1 (2015): 53–57. Print.
@article{5775757,
  abstract     = {Background: We describe a case of a 56-year-old woman who developed a recurrent pleural effusion after a thoracoscopic resection of an anterior bulging thoracic disc hernia (level D9-D10). Despite several evacuating pleural punctions, dyspnea reoccurred due to recurrent pleural effusion, the same side as the disc resection. Because of increasing headache after each punction, a subarachnoidal pleural fistula (SAPF) was suspected. Although magnetic resonance imaging (MRI) showed features suggestive of SAPF, there was not enough evidence to justify a new thorascopy.
Methods: Cerebrospinal fluid (CSF) leakage into the thoracic and abdominal cavity has been described as a result of trauma or surgery. Detection of beta-trace protein (BTP, a brain-specific protein) has been described to detect CSF fistulae causing rhino- and otoliquorrhea. Similarly, BTP determination could be used to identify the presence of CSF at other anatomical sites such as the thoracic cavity. Therefore, we decided to determine the concentration of BTP in the pleural effusion of this patient. BTP was assayed using immunonephelometry.
Results: The patient's BTP pleural fluid concentration was 14{\textperiodcentered}0 mg/l, which was a 25-fold increase compared with the BTP serum concentration. After insertion of a subarachnoidal lumbal catheter, a video-assisted thorascopy was performed. Leakage of liquor through the parietal pleura into the thoracic cavity was observed. The SAPF was closed using a durasis patch and DuraSeal{\textregistered}. Postoperatively, there was no reoccurrence of pleural fluid.
Conclusions: SAPF has to be included to the differential diagnosis of patients with persistent pleural effusion after spinal surgery. This case illustrates the importance of BTP in diagnosing SAPF, especially in cases where major therapeutic consequences may need to be drawn.},
  author       = {DESEYNE, SARAH and Vanhouteghem, Karlien and HALLAERT, GIORGIO and Delanghe, Joris and Malfait, Thomas},
  issn         = {1784-3286},
  journal      = {ACTA CLINICA BELGICA},
  language     = {eng},
  number       = {1},
  pages        = {53--57},
  title        = {Subarachnoidal-pleural fistula (SAPF) as an unusual cause of persistent pleural effusion: beta-trace protein as a marker for SAPF: case report and review of the literature},
  volume       = {70},
  year         = {2015},
}

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