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Ann Thorac Surg 2002;73:1327
© 2002 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Pleuroperitoneal fistula

Anthony P.C. Yim, MD*a, Tak Wai Lee, FRCSa, Innes Y.P. Wan, FRCSa, Calvin Ng, MB, BSa

a Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic Of China

* Address reprint requests to Dr Yim, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic Of China
e-mail: yimap{at}cuhk.edu.hk

A 78-year-old woman with end-stage renal failure was diagnosed to have a pleuroperitoneal fistula when she presented with a massive right hydropneumothorax after peritoneal dialysis (Fig 1). On video-assisted thoracic surgery exploration, the fistula was identified over the dome of the right diaphragm. The fistula was in the shape of a 1.5 cm cystic structure formed by the parietal pleura over a small defect in the diaphragm. When dialysis fluid was infused into the peritoneal cavity, the fluid could be seen coming out through a small hole in the cyst into the chest (Fig 2, arrow). The defect in the diaphragm was closed and the cyst plicated with 3-0 Prolene (Ethicon, Somerville, NJ) using endoscopic suturing. The patient was able to resume peritoneal dialysis postoperatively without further complications.



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