RESUMO
Hepatic hydrothorax is a transudative pleural effusion in patients with cirrhosis. A 56-year-old cirrhotic patient presented with dyspnea and desaturation; his chest images showed a right pleural effusion. Another 66-year-old woman with cirrhosis, developed during her hospitalization acute respiratory failure, and her chest X- ray showed left pleural effusion. Initially, both patients were prescribed a dietary sodium restriction and diuretics. Nevertheless, they didn't have a good response so a chest tube was placed, and an octreotide infusion partially reduced the volume of the pleural drainage allowing a pleurodesis. We report two cases of refractory hepatic hydrothorax with multiple treatments including octreotide and pleurodesis.
Assuntos
Hidrotórax , Cirrose Hepática , Octreotida , Humanos , Hidrotórax/etiologia , Hidrotórax/terapia , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Cirrose Hepática/complicações , Octreotida/uso terapêutico , Pleurodese/métodos , Fármacos Gastrointestinais/uso terapêutico , Drenagem/métodosRESUMO
Despite its rare frequency, a pleuroperitoneal communication is a well-documented complication for patients on peritoneal dialysis. It occurs in ~2% of continuous ambulatory peritoneal dialysis, with uncertain incidence for those on automated peritoneal dialysis. We report a case of a 30-year-old female patient with end-stage kidney disease with sudden dyspnea 2 days after starting automated peritoneal dialysis. Her chest x-ray revealed a significant pleural effusion on the right side. A thoracocentesis was performed, with a pleural glucose/plasma glucose of 1.08. Additionally, a computed tomography scan revealed a pleuroperitoneal communication upon dialysate infusion added with media contrast. A pleural-to-serum glucose gradient of greater than 50 mg/dL may indicate the diagnosis of a pleuroperitoneal communication in patients on peritoneal dialysis. Current literature also indicates that a pleural-to-serum glucose ratio above 1.0 may provide a more sensitive analysis. This case highlights the diagnosis process for this complication, with both laboratory and image findings corroborating the clinical hypotheses of a pleuroperitoneal communication in a patient on automated peritoneal dialysis.
Assuntos
Hidrotórax , Falência Renal Crônica , Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Humanos , Feminino , Adulto , Hidrotórax/etiologia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , GlucoseRESUMO
El hidrotórax hepático es una entidad poco frecuente en pacientes con cirrosis. A la fecha se han propuesto varias alternativas terapéuticas, tanto médicas como quirúrgicas, previas al trasplante hepático como manejo definitivo. A continuación, se presenta el caso de una paciente de 78 años con cirrosis secundaria a infección por virus de la hepatitis C, que acudió al servicio de urgencias por dificultad respiratoria, donde se documentó un derrame pleural derecho masivo de tipo trasudado, que respondió parcialmente a terapia diurética e inserción de dren pleural; posteriormente falleció por complicaciones hemorrágicas asociadas a la cirrosis. Se considera importante describir esta patología, dada su baja frecuencia en pacientes con cirrosis y los retos terapéuticos a los que nos enfrentamos con la poca evidencia disponible en la actualidad.
Hepatic hydrothorax is a rare entity in patients with cirrhosis. To date, several therapeutic alternatives have been proposed, both medical and surgical, prior to liver transplantation as the definitive management. Here we present the case of a 78-year-old patient with cirrhosis secondary to hepatitis C virus infection, who consulted the emergency department for respiratory distress, documenting a massive right pleural effusion of transudate type, which responded partially to diuretic therapy and drainage with pigtail, and later died due to hemorrhagic complications associated with cirrhosis. It is important to describe this pathology given its low frequency in patients with cirrhosis and the therapeutic challenges we face with the limited currently available evidence.
Assuntos
Humanos , Hidrotórax , Derrame Pleural , Drenagem , Vírus de Hepatite , Cirrose HepáticaAssuntos
Âmnio/cirurgia , Medida do Comprimento Cervical , Terapias Fetais/métodos , Hidrotórax/cirurgia , Cavidade Pleural/cirurgia , Toracentese/métodos , Adulto , Âmnio/embriologia , Âmnio/patologia , Colo do Útero/patologia , Feminino , Humanos , Hidrotórax/embriologia , Cavidade Pleural/embriologia , Cavidade Pleural/patologia , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. METHODS: A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated. RESULTS: Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0-36+1). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, p = 0.01), and higher prevalence of PPROM (50 vs. 12%, p = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, p < 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, p < 0.01) compared with pregnancies with normal preoperative CL. CONCLUSION: In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.
Assuntos
Terapias Fetais , Hidrotórax , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Feminino , Feto , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/cirurgia , Recém-Nascido , Gravidez , Estudos ProspectivosRESUMO
Background: Pulmonary hypoplasia is characterized by incomplete development of the lungs, owing to congenital defectsor the action of toxic substances. Moreover, it has rarely been described in pigs. Ascites or hydroperitoneum is characterized by the presence of fluid inside the abdominal cavity and does not generally cause changes in the abdominal organs.However, hydrothorax, characterized by the presence of fluid within the thoracic cavity, is responsible for the compressionof thoracic organs and consequent heart and respiratory failure. This study aims to describe a case of congenital pulmonaryhypoplasia associated with ascites and hydrothorax in a newborn pig.Case: A male neonate Landrace pig that died shortly after delivery was presented for necropsy with increased abdominalvolume and bilateral extension of the pelvic limbs. The pig belonged to a litter of 13 piglets, four of which died shortlyafter birth. The rest of the piglets were poorly developed, but only one was presented for necropsy. Significant externalchanges, along with permanent distension, interpreted as arthrogriposis, were observed in the pelvic limbs. The skin of theventral abdominal region was thin, with evidence of all blood vessels, interpreted as telangectasis. An internal examination revealed the presence of a slightly yellowish liquid in the thoracic and abdominal cavities, interpreted as hydrothoraxand ascites, respectively. The lungs were reduced in size, indicating pulmonary hypoplasia. The liver had rounded edges,which were dark red and firm, with an irregular surface. Significant microscopic findings were observed in the lungs,which were divided by fibrous connective tissue and showed evidence of small and atrophied alveoli. Furthermore, connective tissue was observed around the peribronchiolar regions and underdeveloped cartilage around the airways. The liver...(AU)
Assuntos
Animais , Suínos/anormalidades , Animais Recém-Nascidos/anormalidades , Pulmão/anormalidades , Ascite/veterinária , Hidrotórax/veterinária , Artrogripose/veterináriaRESUMO
Background: Pulmonary hypoplasia is characterized by incomplete development of the lungs, owing to congenital defectsor the action of toxic substances. Moreover, it has rarely been described in pigs. Ascites or hydroperitoneum is characterized by the presence of fluid inside the abdominal cavity and does not generally cause changes in the abdominal organs.However, hydrothorax, characterized by the presence of fluid within the thoracic cavity, is responsible for the compressionof thoracic organs and consequent heart and respiratory failure. This study aims to describe a case of congenital pulmonaryhypoplasia associated with ascites and hydrothorax in a newborn pig.Case: A male neonate Landrace pig that died shortly after delivery was presented for necropsy with increased abdominalvolume and bilateral extension of the pelvic limbs. The pig belonged to a litter of 13 piglets, four of which died shortlyafter birth. The rest of the piglets were poorly developed, but only one was presented for necropsy. Significant externalchanges, along with permanent distension, interpreted as arthrogriposis, were observed in the pelvic limbs. The skin of theventral abdominal region was thin, with evidence of all blood vessels, interpreted as telangectasis. An internal examination revealed the presence of a slightly yellowish liquid in the thoracic and abdominal cavities, interpreted as hydrothoraxand ascites, respectively. The lungs were reduced in size, indicating pulmonary hypoplasia. The liver had rounded edges,which were dark red and firm, with an irregular surface. Significant microscopic findings were observed in the lungs,which were divided by fibrous connective tissue and showed evidence of small and atrophied alveoli. Furthermore, connective tissue was observed around the peribronchiolar regions and underdeveloped cartilage around the airways. The liver...
Assuntos
Animais , Animais Recém-Nascidos/anormalidades , Pulmão/anormalidades , Suínos/anormalidades , Artrogripose/veterinária , Ascite/veterinária , Hidrotórax/veterináriaRESUMO
Abstract Fetal surgery in utero is an alternative for treatable congenital malformations. Prognosis will improve with early correction. Once the surgical technique is planned, the anesthetist's knowledge of maternal and fetal physiology is crucial for the selection of the ideal anesthetic technique for each individual case, considering the type of surgical procedure and the expected degree of fetal stimulation. In this way, the optimal surgical field with maternal and fetal safety will be ensured. This article describes 1 case of twin-to-twin transfusion syndrome under spinal anesthesia and sedation, and a second case of hydrothorax drainage under sedation.
Resumen La cirugía fetal in útero es una alternativa para las malformaciones congénitas tratables, su intervención temprana mejora el pronóstico del feto. Una vez planeada la técnica quirúrgica el conocimiento del anestesiólogo sobre la fisiología materna y fetal es fundamental, puesto que deberá determinar la técnica anestésica ideal acorde al contexto de cada caso considerando el tipo de procedimiento quirúrgico a realizarse y el grado de estimulación fetal esperado. De esta manera se asegura un campo quirúrgico óptimo ofreciendo seguridad materno fetal. En este artículo se describen dos casos: el primero síndrome de transfusión gemelar se realizó bajo anestesia raquídea y sedación, en el segundo caso de drenaje de hidrotórax bajo sedación.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Gêmeos , Transfusão de Sangue Intrauterina , Hidrotórax , Anestesia , Dor , Procedimentos Cirúrgicos Operatórios , Anormalidades CongênitasRESUMO
Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.
Assuntos
Hidrotórax/terapia , Idoso , Ascite/terapia , Tubos Torácicos , Terapia Combinada , Tratamento Conservador , Diuréticos/uso terapêutico , Feminino , Hepatite C/complicações , Humanos , Hidrotórax/etiologia , Hidrotórax/cirurgia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Transplante de Fígado , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Derrame Pleural/terapia , Pleurodese , Derivação Portossistêmica Transjugular Intra-Hepática , ToracenteseRESUMO
Se comunica un caso de hidrotórax agudo derecho en un adolescente de 13 años con Insuficiencia renal crónica terminal (IRCT) en Diálisis Peritoneal Crónica Ambulatoria (DPCA) de sostén. Es una complicación poco frecuente, siendo en nuestra experiencia en el Programa de DPCA del Hospital del Niño Jesús en 12 años de duración, el primer caso. Describimos su evolución, diagnóstico y resolución
A case of right acute hydrotorax is reported in a 13 years old boy with terminal chronic renal failure in CPD (chronic peritoneal diálysis); it is a rare complication and in our experience in the chronic peritoneal dialysis program in Hospital del niño Jesus, Tucuman, in 12 years of duration is the first case. We inform the evolution, diagnosis and resolution.
Assuntos
Humanos , Masculino , Adolescente , Diálise Renal , Diálise Peritoneal , Hidrotórax , Falência Renal CrônicaRESUMO
El hidrotórax hepático (HH) se define como un derrame pleural mayor de 500 ml en pacientes con cirrosis e hipertensión portal. Representa una complicación infrecuente por lo general asociada con ascitis y su origen se relaciona con el paso de líquido ascítico a través de pequeños defectos en el diafragma de predominio en el hemitórax derecho. Una vez establecido el diagnóstico por imágenes, la toracentesis diagnostica permite confirmar un trasudado. La terapia inicial está basada en la restricción de sodio y el uso combinado de diuréticos. El 20-25% de los pacientes desarrolla un HH refractario, el cual requiere intervenciones invasivas tales como la derivación percutánea portosistémica intrahepática (DPPI), la reparación de los defectos diafragmáticos por videotoracoscopia asistida asociada a pleurodésis química y el uso de un catéter pleural tunelizado. No se recomienda la inserción de un tubo de tórax por su elevada morbilidad y mortalidad. El tratamiento definitivo del HH es el trasplante hepático el cual alcanza una excelente sobrevida. Presentamos tres casos de hidrotórax hepático con diferentes enfoques terapéuticos que incluyeron el manejo conservador con dieta y diuréticos, la inserción fallida de un tubo de tórax con pleurodesis y una DPPI.
Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.
Assuntos
Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Hidrotórax/terapia , Derrame Pleural/terapia , Ascite/terapia , Tubos Torácicos , Transplante de Fígado , Hepatite C/complicações , Terapia Combinada , Pleurodese , Derivação Portossistêmica Transjugular Intra-Hepática , Síndrome Metabólica/complicações , Diuréticos/uso terapêutico , Toracentese , Tratamento Conservador , Hidrotórax/cirurgia , Hidrotórax/etiologia , Hipertensão Portal/complicações , Cirrose Hepática/complicaçõesRESUMO
Introducción: el hematoma mediastinal es una causa rara de complicación en el abordaje de la vía venosa central (VVC). Estudio de Gupta 2011 reportó uno y revisó varios casos clínicos analizando la conducta terapéutica. Caso clínico: mujer de 51 años con ventilación mecánica invasiva en terapia intensiva por encefalitis viral, que después de la colocación de VVC subclavia presentó inestabilidad hemodinámica, dificultad para ventilar con resistencias elevadas y compliance disminuida, hace paro cardiaco que revierte con maniobras, se precisa diagnóstico de hematoma mediastinal y se indica manejo conservador con el que evoluciona satisfactoriamente. Discusión: el hematoma de mediastino siempre debe sospecharse y es evidente en radiografías de tórax en los casos graves, con ensanchamiento mediastinal. La ventilación mecánica establece una presión positiva intratorácica permitiendo contener el hematoma, el manejo conservador se reporta beneficioso. Conociendo que las complicaciones de colocación de VVC son mínimas pero con elevado riesgo de inestabilidad, prolongación de hospitalización y aumento de la mortalidad, se recomienda evitar abordajes innecesarios, en especial subclavios.
Background: Mediastinal hematoma is an uncommon complication from the central venous access. The Gupta's trial 2011 reported one case and a review of other similar cases, 3 cases were treated with coil embolisation by vascular lesion, another 3 cases who needs thoracotomy for hemothorax complication and just 2 cases was established a conservative management in which only one survived. Clinical case: 51-year-old female in invasive mechanical ventilation admitted to intensive care unit (ICU) due to viral encephalitis, present hemodynamic instability and difficulty to ventilate by high resistance and low compliance after of a subclavian venous access, then complicated with cardiac arrest that reverted in 5 min with resuscitation maneuvers, we made a conservative management with continuous infusion of norepinephrine and invasive mechanical ventilation with protective technique (PEEP 10, TV6cc/kg), the requirements of norepinephrine decrease progressively, then the patient was disconnected from mechanical ventilation and was discharged from the intensive care satisfactorily. Discussion: Mediastinal hematoma should always be suspected and is evident with chest X-rays just when it is a severe case and it is suspicioned with wide mediastinum. Conservative management to this case into intensive care unit could be beneficial. Mechanical ventilation establishes a positive intra-thoracic pressure allowing the hematoma to be contained. Knowing that the complications of central venous access are minimal but these complications have high risk of instability, prolonged hospitalization and increased mortality. It is recommended avoid unnecessary central venous access, mainly subclavian access
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças do Mediastino , Hemotórax , Hidrotórax , MediastinoRESUMO
Se presenta el caso de un paciente de sexo masculino de 39 años, portador de colangitis esclerosante primaria desde hace 9 años, complicado con síndrome de hipertensión portal más insuficiencia hepática, en plan de trasplante hepático, en seguimiento por el Servicio de Gastroenterología. Ingresa por dificultad respiratoria, constatándose derrame pleural izquierdo extenso con características de trasudado con ascitis moderada, por lo que se procede al drenaje del líquido pleural y ascítico con goteo concomitante de albúmina endovenosa. El paciente presenta buena tolerancia y disminución importante tanto del derrame pleural como del líquido ascítico. Es dado de alta en mejores condiciones y con aumento de dosis de fármacos para el tratamiento de la ascitis
We present the case of a male patient 39 years old, with a history of primary sclerosing cholangitis for 9 years, complicated with portal hypertension and liver failure, he is in liver transplant program, followed up by Gastroenterology Service. He was admitted for respiratory failure, and massive left pleural effusion, with of features transudate and moderate ascites was noted aswell, we performes pleural and ascitic fluid drainage with concomitant infusion of intravenous albumin. The patient shows good tolerance and significant decrease in both pleural effusion and ascitic fluid. He was discharged in better condition and with increased doses of drugs for the treatment of ascites
Assuntos
Humanos , Masculino , Adulto , Colangite , Hidrotórax , Derrame PleuralRESUMO
Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the development of HH remains incompletely understood, the most acceptable explanation is that the pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm due to the raised abdominal pressure and the negative pressure within the pleural space. Patients with HH can be asymptomatic or present with pulmonary symptoms such as shortness of breath, cough, hypoxemia, or respiratory failure associated with large pleural effusions. The diagnosis is established clinically by finding a serous transudate after exclusion of cardiopulmonary disease and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces when necessary. Spontaneous bacterial empyema is serious complication of HH, which manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. The mainstay of therapy of HH is sodium restriction and administration of diuretics. When medical therapy fails, the only definitive treatment is liver transplantation. Therapeutic thoracentesis, indwelling tunneled pleural catheters, transjugular intrahepatic portosystemic shunt and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality is high in these extremely ill patients.
Assuntos
Hidrotórax/etiologia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Derrame Pleural/etiologia , Infecções Bacterianas/microbiologia , Empiema/microbiologia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/mortalidade , Hipertensão Portal/diagnóstico , Hipertensão Portal/mortalidade , Hipertensão Portal/terapia , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Transplante de Fígado , Derrame Pleural/diagnóstico , Derrame Pleural/mortalidade , Derrame Pleural/terapia , Derivação Portossistêmica Transjugular Intra-Hepática , Valor Preditivo dos Testes , Fatores de Risco , Toracentese , Toracoscopia , Resultado do TratamentoRESUMO
La enfermedad Hepática es una causa importante de morbilidad y Mortalidad en el mundo; asociada a compromiso orgánico múltiple. En el pulmón, tres condiciones clínicas han sido descritas; estos cuadros Incluyen, el Síndrome Hepatopulmonar (SHP), que obedece a un trastorno de la oxigenación por dilatación de la vasculatura pulmonar. La hipertensión portopulmonar (HPP), mediada por desequilibrio entre agentes vasodilatadores y vasoconstrictores que conducen a un aumento de la presión media de la arteria pulmonar y por último el Hidrotórax Hepático (HH), que es la condición menos prevalente, se fundamenta principalmente en anomalías anatómicas del diafragma, con o sin relación a la presencia de ascitis. La presencia SHP o HPP es predictor independiente de mortalidad, resaltando su importancia en la elegibilidad de pacientes para trasplante hepático ortotópico como medida curativa.
Liver disease is a major cause of morbidity and mortality in the world; it is associated with multiple organ involvement. In the lung, three clinical conditions are described; these conditions include, Hepatopulmonary Syndrome (HPS), which is due to a oxygenation defect by the development of pulmonary vascular dilatation. Portopulmonary (HPP) hypertension, it's mediated by an imbalance between vasodilator and vasoconstrictor agents leading to an increase in mean pulmonary artery pressure and finally the Hydrothorax Liver (HH), that is the least prevalent condition, it's based on anatomical diaphragm abnormalities, with or without ascites. The presence of SHP or HPP is an independent predictor of mortality, highlighting its importance in the eligibility of patients for orthotopic liver transplantation as a curative measure.
A doença hepatica é uma das principais causas de morbidade e mortalidade no mundo; está associado ao compromisso de vários órgãos. No pulmão, três condições clínicas são descritas; estas condições incluem, Síndrome Hepatopulmonar (HPS), que é devido a um defeito de oxigenação do dilatação vascular pulmonar. A hipertensão portopulmonar (HPP), é mediada por um desequilíbrio entre vasodilatadores e agentes vasoconstritores, levando a um aumento da pressão arterial média da artéria pulmonar e, finalmente, ao hidrotorax hepatico (HH), essa é a condição menos prevalente, é baseada em anormalidades anatômicas do diafragma, com ou sem ascite. A presença de SHP ou HPP é um preditor independente de mortalidade, destacando sua importância na elegibilidade de pacientes para transplante de hepatico como medida curativa.
Assuntos
Humanos , Fibrose , Transplante de Fígado , Síndrome Hepatopulmonar , Hidrotórax , Hipertensão PulmonarRESUMO
The hydrothorax is a known but rare complication of acute and chronic peritoneal dialysis. Patients with hemolytic uremic syndrome seem to be more prone to this complication. Usually discontinuation of treatment is necessary due to the lack of resolution or recurrence of hydrothorax and transfer to hemodialysis, but some patients can continue dialysis with modification of technique and with resolution of hydrothorax. CASE REPORT: a child with hemolytic uremic syndrome presented a massive hydrothorax during acute peritoneal dialysis which resolved with dialysis schema modification without interruption of treatment.
El hidrotórax es una complicación conocida pero infrecuente de la diálisis peritoneal aguda y crónica. Los pacientes con síndrome urémico hemolítico parecieran estar más predispuestos a esta complicación. Habitualmente, es necesaria la interrupción del procedimiento debido a la falta de resolución o recurrencia del hidrotórax y la transferencia a hemodiálisis. Sin embargo, algunos pacientes pueden continuar dializándose sin dificultad con alguna modificación de la técnica y resolución del hidrotórax. Se describe una niña con síndrome urémico hemolítico, que presentó un hidrotórax masivo durante la diálisis peritoneal aguda, que se resolvió con la modificación del esquema de diálisis sin interrupción del procedimiento.
Assuntos
Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/etiologia , Hidrotórax/etiologia , Diálise Peritoneal , Tratamento Conservador , Feminino , Humanos , LactenteRESUMO
We present two cases of misplaced central venous catheters having in common theabsence of free blood return from one lumen immediately after placement. The former is acase of right hydrothorax associated with central venous catheterization with the catheter tipin intra-pleural location. In this case the distal port was never patent. In the latter case therewas an increased aspiration pressure through the middle port due to a catheter looping.The absence of free flow on aspiration from one lumen of a central catheter should not beundervalued. In these circumstances the catheter should not be used and needs to be removed.
Apresentamos dois casos de mau posicionamento de cateter venoso central. Têmem comum a ausência do retorno sanguíneo livre em um dos lúmens imediatamente após acolocac¸ão. O primeiro é um caso de hidrotórax direito associado ao cateterismo venoso central,com a ponta do cateter em localizac¸ão intrapleural. Nesse caso, a porta distal nunca estevepatente. No segundo caso houve um aumento da pressão de aspirac¸ão através da porta medialpor causa da formac¸ão de alc¸a no cateter.A ausência de fluxo livre na aspirac¸ão de um lúmen do cateter central não deve ser subesti-mada. Nessas circunstâncias, o cateter não deve ser usado e deve ser removido.
Assuntos
Humanos , Feminino , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Hidrotórax/etiologia , Falha de Equipamento , Hidrotórax/diagnóstico por imagemRESUMO
We present two cases of misplaced central venous catheters having in common the absence of free blood return from one lumen immediately after placement. The former is a case of right hydrothorax associated with central venous catheterization with the catheter tip in intra-pleural location. In this case the distal port was never patent. In the latter case there was an increased aspiration pressure through the middle port due to a catheter looping. The absence of free flow on aspiration from one lumen of a central catheter should not be undervalued. In these circumstances the catheter should not be used and needs to be removed.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Hidrotórax/etiologia , Adulto , Idoso , Falha de Equipamento , Feminino , Humanos , Hidrotórax/diagnóstico por imagemRESUMO
Descreve-se um surto de intoxicação por Metternichia princepsem caprinos no Estado da Bahia. De oito caprinos, três morreram, dos quais dois foram necropsiados; cinco não adoeceram. Os principais sinais clínicos caracterizaram-se por secreção nasal mucosa, emagrecimento, diarreia, apatia, debilidade leve, andar cambaleante, flexão dos membros torácicos e pélvicos, decúbito esterno-abdominal e decúbito lateral, seguidos de morte após aproximadamente dois dias de evolução clínica. Na necropsia foi observado edema pulmonar, hidrotórax, hidropericárdio, ascite, rins pálidos, edema perirrenal e hemorragias no tecido subcutâneo. Microscopicamente nos rins havia acentuada necrose de coagulação do epitélio tubular e túbulos com regeneração do epitélio. No pulmão havia acentuada congestão associada a edema interalveolar e interseptal. Na bioquímica sanguínea observou-se aumento na ureia, creatinina e creatinina fosfoquinase.
An outbreak of poisoning by Metternichia princepsis reported in goats from the State of Bahia. Out of eight goats three showed symptoms of poisoning and died; on two of them post-mortem examinations were performed. The main clinical signs were nasal mucous secretion, weight loss, diarrhea, lethargy, mild weakness, staggering gait, flexion of the fore and hind limbs, sternal recumbence, and lateral recumbence followed by death after approximately two days of clinical manifestations. The serum concentration of urea and creatinine and the serum activities of creatine phosphokinase were increased. At necropsy pulmonary edema, hydrothorax, hydropericardium, ascites, pale kidneys, perirenal edema and hemorrhages in the subcutaneous tissue were observed. Microscopically the kidneys showed accentuated coagulation necrosis of the tubular epithelium and tubules and epithelial regeneration. In the lungs there was accentuated congestion associated with interalveolar and interseptal edema.