ABSTRACT

A subarachnoid pleural fistula — a connection between the pleural cavity and the subarachnoid space — generally presents after trauma or surgery. A 1-year 11-month-old girl without a history of trauma or surgery presented with fatigue, cyanosis and dyspnoea. A chest radiograph and computed tomography (CT) demonstrated a massive pleural effusion in the right hemithorax. About 300 ml of a crystal-clear pleural effusion, which looked like pure water, was removed by insertion of a chest drain, but it continued to collect. Cisternography and CT myelography confirmed leakage of cerebral spinal fluid into the right pleural cavity around the thoracolumbar region. Magnetic resonance imaging demonstrated an 11-mm enhanced nodule in the epidural space around the right lumbar (L) 1/2 intervertebral foramen. The patient underwent surgery and epidural tumours attached to the L1 nerve root foramen were completely resected and a fistula of the dura adjacent to the tumour was sutured. Histopathological examination demonstrated a mature teratoma containing a pancreatic component. On retrospective analysis of stored pleural fluid, a raised level of pancreatic enzymes was detected. It is presumed that digestive enzymes secreted by the pancreatic component of the teratoma lysed the dura, resulting in formation of the fistula. When a crystal-clear pleural effusion is present, even in the absence of trauma or surgery, a subarachnoid pleural fistula should be considered. As far as we know, this is the first report of a subarachnoid pleural fistula caused by a paravertebral teratoma.

Abbreviations: CSF: cerebrospinal fluid; CT: computed tomography; ¹¹¹In-DTPA: indium-111 diethylene triamine penta-acetic acid; MRI: magnetic resonance imaging; NIPPV: non-invasive positive pressure ventilation.

摘要

蛛网膜下腔胸膜瘘——胸膜腔和蛛网膜下腔之间的连接——通常出现在创伤或手术后。一名 1 岁 11 个月大的女孩，没有外伤或手术史，表现为疲劳、紫绀和呼吸困难。胸片和计算机断层扫描 (CT) 显示右半胸大量胸腔积液。通过置入胸腔引流管引出约 300 ml 晶莹剔透的胸腔积液，看起来像纯净水，但仍继续积聚。脑池造影和 CT 脊髓造影证实脑脊液漏入胸腰段周围的右侧胸膜腔。磁共振成像显示右侧腰椎 (L) 1/2 椎间孔周围的硬膜外腔有一个 11 毫米增强的结节。患者接受了手术，完全切除了附着在L1神经根孔的硬膜外肿瘤，并缝合了与肿瘤相邻的硬脑膜瘘管。组织病理学检查显示含有胰腺成分的成熟畸胎瘤。在对储存的胸水进行回顾性分析时，检测到胰酶水平升高。据推测，畸胎瘤的胰腺成分分泌的消化酶溶解了硬脑膜，导致了瘘管的形成。当存在晶莹剔透的胸腔积液时，即使没有外伤或手术，也应考虑蛛网膜下腔胸膜瘘。据我们所知，这是第一次报道椎旁畸胎瘤引起的蛛网膜下腔胸膜瘘。

缩写： CSF：脑脊液；CT：计算机断层扫描；¹¹¹ In-DTPA：铟-111二亚乙基三胺五乙酸；MRI：磁共振成像；NIPPV：无创正压通气。