RESUMO
A-75-year-old man had refractory late cardiac tamponade after an off-pump coronary artery bypass grafting. He was initially treated by pericardiocentesis with oral nonsteroidal anti-inflammatory drugs, but the treatment failed. Pericardial fenestration was conducted twice for refractory pericardial effusion during his hospitalization. He presented again with recurrence of cardiac tamponade 2 months after the last pericardial fenestration. Therefore, a pleuroperitoneal shunt system was implanted. He recovered well and was discharged without reaccumulation of pericardial effusion.
RESUMO
Repeated needle thoracocentesis, tube thoracotomy, or pleurodesis are generally performed as a palliative treatment for malignant pleural effusion. However, these methods have an unsatisfactory success rate, require lengthy hospital stays, and induce pain and various inconvenience accompanying frequent treatment or catheterization, indicating unsatisfactory palliative care. Here, we experienced a case of malignant pleural effusion treated by pleuroperitoneal shunt. The patient was suffering from lung cancer in his eighties. Although the patient wished to be treated at home, uncontrollable pleural effusion forced him to remain in the hospital. By inserting Denver pleuroperitoneal shunt (Denver Biomaterials, Inc., Denver, CO, USA), he could return home. This method may be an effective treatment option in palliative care, particularly palliative home care, for patients with malignant pleural effusions. Palliat Care Res 2008; 3(2): 326-330
RESUMO
Chylothorax is an accumulation of lymphatic fluid or chyle in the pleurual cavity resulting from a leak of the thoracic duct or one of its major divisions. If the loss of chyle persist, life threatening nutritional and immunologic deficiencies ensue. Initial conservative managements consist of tube thoracostomy drainage and dietary modification(low fat diet and total parenteral nutrition). In some refarctory cases, surgical intervention is required. Pleuroperitoneal shunt is an alternative surgical method recommended prior to thoracic duct ligation. The shunted fluid in the peritoneal cavity is reabsorbed by peritoenal lymphatic vessels running to join the right lymphatic duct. We experienced a case of chylothorax in a two-month-old female infant. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. She failed to respond to conservative management and showed severe hypoalbuminemia and lymphopenia. On day 22, a pleuroperitoneal shunt was inserted between the right pleural cavity and the peritoneal cavity. Three weeks after insertion of the shunt, there was no fluid in the right pleural space. After one more week of observation, the shunt was removed.