title: Traumatic subarachnoid-pleural fistula.
abstract: BACKGROUND
  Traumatic subarachnoid-pleural fistula is a very uncommon but important condition. Only 21 cases have been reported so far in the world literature.
  
  
  METHODS
  We encountered 2 cases of subarachnoid-pleural fistula, both in pediatric patients presenting without any neurologic deficit. Whereas our first patient presented with recurrent, rapidly filling clear pleural effusions with an obscure cause, posing a diagnostic problem for the pediatricians, the second patient had trauma to the pleura and dura mater by the sharp edge of Kirschner wire, with impending risk of injury to spinal cord and infection.
  
  
  RESULTS
  Surgical intervention was undertaken after we had a strong suspicion of subarachnoid-pleural fistula in both cases. A subarachnoid-pleural fistula was found at the level of the eleventh thoracic vertebra in the first patient and at the level of the eighth thoracic vertebra in the second patient. Autogenous tissues (mediastinal pleural flap and hammered intercostal muscle covered with methylcellulose) were used to repair the fistula. The subarachnoid space was decompressed with a lumbar drain in the second patient.
  
  
  CONCLUSIONS
  The diagnosis of subarachnoid-pleural fistula is difficult when it is not associated with any neurologic deficit. We found that a high degree of suspicion and early surgical intervention to repair the fistula are rewarding.
authors.affiliation: Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: V
authors.initials: V
authors.lastname: Sarwal
authors.forename: R K
authors.initials: RK
authors.lastname: Suri
authors.forename: O P
authors.initials: OP
authors.lastname: Sharma
authors.forename: A
authors.initials: A
authors.lastname: Baruah
authors.forename: P
authors.initials: P
authors.lastname: Singhi
authors.forename: S
authors.initials: S
authors.lastname: Gill
authors.forename: J R
authors.initials: JR
authors.lastname: Bapuraj
mesh_terms: D001864:Bone Wires / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater / Q000293:injuries*; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D010996:Pleural Effusion / Q000209:etiology; D011859:Radiography; D016103:Spinal Fractures / Q000150:complications; D013346:Subarachnoid Space; D013904:Thoracic Vertebrae / Q000293:injuries