Korean J Anesthesiol.  2015 Apr;68(2):184-187. 10.4097/kjae.2015.68.2.184.

Hydrothorax with alveolar-pleural fistula mimicking re-expansion pulmonary edema during liver transplantation: a case report

• Woo JH
• Chung RK
• Baik HJ
• Kim YJ

• KMID: 2236160
• DOI: http://doi.org/10.4097/kjae.2015.68.2.184

Abstract

We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation, which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotracheal tube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosed with an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmatic incision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusion towards the ipsilateral lung during the remaining operation period. Surgeon repaired the defect on the exposed lung surface via diaphragmatic opening. Anesthesiologists should consider an alveolar-pleural fistula as a possible differential diagnosis with re-expansion pulmonary edema when transudate emanating from the endotracheal tube is obtained in patients with massive hydrothorax.

Keyword

Fistula; Hydrothorax; Liver transplantation

MeSH Terms

Diagnosis, Differential
Drainage
Exudates and Transudates
Fistula*
Humans
Hydrothorax*
Liver Transplantation*
Lung
Pleural Effusion
Positive-Pressure Respiration
Pulmonary Edema*
Ventilation