ABSTRACT
INTRODUCTION: The development of a sero-sanguinous pleural effusion is a rare, often overlooked, manifestation of a ruptured infected aneurysm of the abdominal aorta. CASE REPORT: A man of 84years was referred for management of a left-sided pleural effusion associated with symptoms of infection. He had presented two months previously with methicillin resistant staphylococcal septicaemia, the origin of which was a plantar ulcer. The patient was apyrexial and had no abdominal pain. A thoraco-abdominal CT scan without contrast showed a peri-aortic abdominal mass suggesting a tumour. A contrast enhanced scan and peri-aneurysmal aspiration showed that it was an infected aneurysm of the abdominal aorta that had ruptured into the left pleural cavity. The progress was unfavourable despite double antibiotic therapy. CONCLUSION: In the face of a sero-sanguinous pleurisy, particularly if associated with unexplained symptoms of infection, a search should be made for an abdominal aortic aneurysm. Surgical treatment of the aneurysm should be undertaken if the general condition of the patient and the localisation and morphology of the aneurysm permit.
Subject(s)
Aneurysm, Infected/diagnosis , Aortic Aneurysm, Abdominal/diagnosis , Aortic Rupture/diagnosis , Methicillin Resistance , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Pleurisy/diagnosis , Sepsis/diagnosis , Staphylococcal Infections/diagnosis , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Disease Progression , Drug Therapy, Combination , Fatal Outcome , Humans , Male , Multiple Organ Failure/etiologyABSTRACT
INTRODUCTION: Gastropleural fistula has only rarely been described in the literature, typically presenting with evidence of left-sided pleural infection. CASE REPORT: The diagnosis may be suggested by the occurrence of chest pain and repeated vomiting with the diagnosis confirmed by microbiological examination of the pleural fluid and appropriate radiological investigations. The fistula occurs most frequently after abdominal or anterior thoracic surgery. Generally, surgical repair should be performed urgently but in the case that we describe occurring during pregnancy, surgery was delayed for 10 weeks until a caesarean section could be performed. CONCLUSION: In the presence of left-sided basal pleuritic chest pain in the context of a possible gap in the diaphragm the diagnosis of gastropleural fistula should be considered. Treatment is usually a medico-surgical emergency.
