Pleuroperitoneal shunts and tumor seeding.
A 76-year-old man with malignant mesothelioma of the left pleura was referred for surgical palliation. He was dyspneic at rest and had anterior chest pain and a persistent cough. Chest x-ray film revealed an extensive left pleural effusion. A thoracoscopy was performed, and 3L of pleural fluid was drained. Both the pleural surfaces and rhe diaphragm were studded with tumors. On maximal inflation of the lung, the parietal and visceral pleura did not oppose, and therefore a Denver shunt was inserted. At 6 weeks follow-up, the shunt was performing satisfactorily. At follow-up 9 weeks postoperatively, the subcutaneous tunnel was infiltrated by mesothelioma over a distance of some 15 cm.
Department of Thoracic Surgery, Royal Devon and Exeter Hospital, Exeter EX2 5 DW, United Kingdom.
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Baeyens
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Berrisford
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000150:complications / Q000556:secondary*; D009366:Neoplasm Seeding; D010534:Peritoneal Neoplasms / Q000556:secondary*; D010537:Peritoneum / Q000601:surgery*; D010994:Pleura / Q000601:surgery*; D016066:Pleural Effusion, Malignant / Q000601:surgery*; D010997:Pleural Neoplasms / Q000473:pathology*