title: Two cases of massive pleural effusion noted only after induction of anesthesia in living donor liver transplantation.
abstract: Two adult patients who underwent living donor liver transplantation with acute accumulation of right-side pleural effusion are reported. The chest X-ray of patient 1 showed no specific finding 3 days before the operation, and patient 2 was known to have pleural effusion and underwent pigtail drainage before transplant. After anesthesia induction and insertion of central venous catheters, a portable chest radiograph was taken to confirm the positions of the central venous catheters and endotracheal tube. A massive right-side pleural effusion was noted unexpectedly in both patients. Approximately 2,000 ml transudative fluid was surgically drained through the right diaphragm in patient 1 upon opening of the abdominal cavity. The acute accumulation of massive pleural fluid in patient 2 was caused by clamping of the pigtail drainage tube during patient transfer to the operating room; upon unclamping of the tube, 2,000 ml fluid was drained. The intraoperative and postoperative transplant courses of both patients were uneventful. Both were discharged from the hospital in stable condition. Our cases suggest that chest X-ray after induction of the anesthesia and before liver transplantation surgery is recommended. In addition to documenting the positions of the central venous catheters and endotracheal tube, a potential life-threatening pleural effusion requiring appropriate management may be detected.
authors.affiliation: Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, Medicine College, Ta-pei Rd. 123, Niao Shung Hsiang, Kaohsiung, Taiwan, ROC.
authors.forename: Sin-Ei
authors.initials: SE
authors.lastname: Juang
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Wen-Tzu
authors.initials: WT
authors.lastname: Liao
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Kwok-Wai
authors.initials: KW
authors.lastname: Cheng
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Huang
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Shao-Chun
authors.initials: SC
authors.lastname: Wu
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
mesh_terms: D000758:Anesthesia; D001826:Body Fluids / Q000502:physiology; D002405:Catheterization, Central Venous; D003250:Constriction; D004322:Drainage; D058625:End Stage Liver Disease / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography