The squirting bleb: image and treatment of inspiration-linked leakage of a peritoneopleural fistula.
A 25 year old man with known chronic right sided heart failure and ascites due to a congenital heart defect presented with dyspnoea and a massive pleural effusion. Thoracoscopy revealed two diaphragmatic blebs. Changes in peritoneal and thoracic pressure during respiration resulted in periodic squirting of a ruptured bleb, illustrating preferential flow of peritoneal fluid into the thorax. The pleural effusion was successfully treated with drainage of ascitic fluid and chemical pleurodesis.
Krouwels
F H
FH
Department of Pulmonology, OLVG Hospital, 1090 HA Amsterdam, The Netherlands. F.H.Krouwels@olvg.nl
Bresser
P
P
D000328:Adult; D003964:Diaphragm; D004417:Dyspnea / Q000209:etiology; D005402:Fistula / Q000150:complications*; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008297:Male; D009135:Muscular Diseases / Q000150:complications; D010532:Peritoneal Diseases / Q000150:complications*; D010995:Pleural Diseases / Q000150:complications*