An Unusual Transudative Pleural Effusion Succeeded by Pulmonary and Brain Edema and Death

Sayyed Gholam Reza Mortazavimoghaddam,H R Riasi

doi:10.1155/2012/896409

Sayyed Gholam Reza Mortazavimoghaddam, H R Riasi

Open Access

https://doi.org/10.1155/2012/896409

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Abstract

Here we report a 22-year old woman with massive and bilateral transudative effusion succeeded by pulmonary edema and brain edema and death. Investigations for systemic disorders were negative. Exacerbation of dyspnea after intravenous fluid infusion was a main problem. As effusion was refractory to medical treatment, the patient was referred for surgical pleurodesis and bilateral surgical pleurodesis were done separately. Postsurgically, dyspnea exacerbation occurred after each common cold infection. Vertigo and high intracranial pressure were also a problem postsurgically. CSF pressure was 225 mm/H2O. Therapeutic lumbar puncture was done in two sequential weeks, and the patient was on acetazolamide 250 mg/trivise a day. Despite the medical treatment, progressive dyspnea, headache, and high intracranial pressure followed by death nine months after pleurodesis. As there is a gradient of pressure between pleura and CSF, after pleurodesis brain edema must be a consequence of inversing this gradient. In conclusion, when there are any abnormalities about fluid volume or pressure in any of these cavities, we have to study other cavities.

Highlights

Transudative pleural effusion is usually due to systemic condition and the pleural surfaces are intact per se
There is the first report of massive and bilateral transudative pleural effusion complicated by increased intracranial hypertension and several bout of pulmonary edema, succumbed the patient to death nine months after bilateral pleurodesis
High daily drainage during chest tube insertion, several bouts of pulmonary edema, and cerebral edema after bilateral pleurodesis were problematic for our patient

Summary

Introduction

Transudative pleural effusion is usually due to systemic condition and the pleural surfaces are intact per se. In the absence of systemic condition such as cardiac or liver disease and in the absence of anatomical connection between pleura and space with transudative effusion, there has not been report of such refractory massive and bilateral transudative pleural effusion. There is the first report of massive and bilateral transudative pleural effusion complicated by increased intracranial hypertension and several bout of pulmonary edema, succumbed the patient to death nine months after bilateral pleurodesis. After initial examination and radiographic study, diagnosis of bilateral pleural effusion was ascertained (Figure 1). In her past medical history, recurrent headache, vertigo, and exacerbation of dyspnea after intravenous fluid infusion were reported. Tapped fluid from pleural cavity was sent for biochemistry, cytological, and microbiologic studies

Case Reports in Pulmonology

Discussion