Intrathoracic Fluid Extravasation After Hip Arthroscopy

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The case of intrathoracic extravasation of irrigation fluid after hip arthroscopy in a 21-year-old woman is presented. In this patient intraperitoneal and retroperitoneal fluid collection developed, as seen in other case reports documenting irrigation fluid extravasation during hip arthroscopy. The patient presented to the emergency department on the first postoperative day complaining of shortness of breath. Computed tomography of the chest, abdomen, and pelvis showed retroperitoneal fluid, extensive abdominal ascites, and bilateral pleural effusions within the chest. The fluid diminished pulmonary volume by elevating the diaphragm and causing compression atelectasis of both lungs. The patient's hemodynamic status was stable and unaffected. She developed hypothermia during the procedure, which is consistent with other reports on extravasated irrigation fluid during arthroscopy. She was able to rapidly compensate for fluid overload and eliminated it uneventfully, with resolution of her symptoms. A similar procedure was performed on the contralateral hip 6 months later. During that procedure, there was a suspected (not confirmed) recurrence of intraperitoneal extravasation of the pump fluid as well as transient hypothermia, which resolved by the first postoperative visit. The physiologic effects of intrathoracic fluid accumulation and the literature regarding extravasation of irrigation fluid during hip arthroscopy are also reviewed.