Single-trocar thoracoscopic pericardio-pleural fenestration under local anesthesia for malignant pleural effusion: a case report

Masatsugu Ohuchi,Yoshitomo Ozaki,Shuhei Inoue,Yuki Namura,Keiko Ueda

doi:10.1186/s40792-019-0694-6

Masatsugu Ohuchi, Yoshitomo Ozaki + Show 3 more

Open Access

https://doi.org/10.1186/s40792-019-0694-6

Copy DOI

Abstract

BackgroundPericardio-pleural fenestration by video-assisted thoracoscopic surgery is an efficient procedure for malignant pericardial effusion, but requires general anesthesia with single-lung ventilation.Case presentationA 43-year-old woman was referred with complaints of deteriorating dyspnea and orthopnea. Chest computed tomography revealed right massive pleural effusion and pericardial effusion. Echocardiography demonstrated collapse of both the right atrium and right ventricle due to cardiac tamponade. Semi-rigid thoracoscopic pleural biopsy and pericardio-pleural fenestration were successfully performed under local anesthesia via a single trocar, because surgical procedures under general anesthesia with single-lung ventilation might have been intolerable for the patient. Adequate biopsy specimens of pleura and pericardium and immediate relief of serious symptoms were obtained without perioperative complications. No recurrence of pleural or pericardial effusion was observed for 3 months postoperatively.ConclusionThoracoscopic pericardio-pleural fenestration under local anesthesia via a single trocar is feasible as an alternative approach in critically ill patients, allowing effective pericardial drainage, evaluation of the pleural cavity, and accurate biopsies of the pericardium and parietal pleura simultaneously.

Highlights

Pericardio-pleural fenestration by video-assisted thoracoscopic surgery is an efficient procedure for malignant pericardial effusion, but requires general anesthesia with single-lung ventilation.Case presentation: A 43-year-old woman was referred with complaints of deteriorating dyspnea and orthopnea
Thoracoscopic pericardio-pleural fenestration under local anesthesia via a single trocar is feasible as an alternative approach in critically ill patients, allowing effective pericardial drainage, evaluation of the pleural cavity, and accurate biopsies of the pericardium and parietal pleura simultaneously
Because surgical procedures under general anesthesia with single-lung ventilation might have proven intolerable, thoracoscopic examination and pleural biopsy were performed under local anesthesia and light sedation by midazolam

Summary

Conclusion

A single-trocar thoracoscopic pericardio-pleural fenestration under local anesthesia is a feasible approach in critically ill patients that allows effective pericardial drainage, evaluation of pleural cavity, and accurate biopsy of pericardium and parietal pleura simultaneously.

Background

Findings

Discussion