Subarachnoid-pleural fistula in an infant treated with mechanical positive-pressure ventilation.
OBJECTIVE
To report a pediatric case of subarachnoid-pleural fistula, its diagnosis, and its treatment.


METHODS
Case report.


METHODS
Pediatric intensive care unit.


METHODS
A 9-month-old boy, presenting with severe pleural effusion after posterior chest wall surgery.


METHODS
Subarachnoid-pleural fistula was confirmed by isolating beta2-transferrin in the pleural fluid and with magnetic resonance cisternography revealing the location. The patient had a healthy outcome, and the fistula dried without surgery, using positive-pressure ventilation and a chest drain.


CONCLUSIONS
We used beta2-transferrin to confirm the diagnosis of clinically suspected subarachnoid-pleural fistula. High-resolution computed tomographic and magnetic resonance cisternography are the best techniques to localize the fistula. The currently recommended treatment is surgery; we suggest that bilevel positive-pressure ventilation, especially with noninvasive techniques, could be a treatment alternative, reducing the flow of cerebral spinal fluid through the fistula and allowing spontaneous closure.
Valla
Frédéric V
FV
Pediatric Intensive Care Unit, Debrousse Pediatric University Hospital, Lyon, France. frederic.valla@chu-lyon.fr
D004322:Drainage; D006801:Humans; D007223:Infant; D008297:Male; D010995:Pleural Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011175:Positive-Pressure Respiration; D016156:Respiratory Tract Fistula / Q000150:complications / Q000628:therapy*; D013346:Subarachnoid Space; D033882:Transferrin-Binding Protein B / Q000032:analysis
D033882:Transferrin-Binding Protein B