Platypnea–orthodeoxia syndrome in a postoperative patient: a case report

Background We report a case of platypnea–orthodeoxia syndrome observed in a complex clinical situation associating a bilateral pleural effusion, lobar pulmonary embolism, and a partial anomalous pulmonary venous return. Case presentation A 57-year-old Caucasian woman developed acute dyspnea in the postoperative course of an elective gynecological surgery for advanced stage ovarian cancer. Preoperative evaluation had failed to reveal any respiratory or cardiac problem. After evidence of a low arterial oxygen saturation, blood gas analysis from the central venous line correctly inserted in the right internal jugular vein revealed a higher oxygen saturation than in the arterial compartment. A thoracic computed tomography showed bilateral pleural effusion, lobar pulmonary embolism, and a drainage of a left pulmonary vein into the left innominate vein. This unique combination resulted in an uncommon cause of platypnea–orthodeoxia syndrome. Conclusion Often associated with right-to-left shunting, platypnea–orthodeoxia syndrome may be observed in complex clinical conditions with several factors influencing the ventilation/perfusion ratio. The paradoxical finding of a higher oxygen saturation in a central venous line than in an arterial line should prompt the clinician to look at the possibility of partial anomalous pulmonary venous return. No specific treatment is required in asymptomatic adults, except for an echocardiographic follow-up to detect the onset of pulmonary hypertension.

A rare cause of bilateral pleural effusion – desmoplastic small round cell tumor

Desmoplastic small round cell tumor (DSRCT) is a rare, extremely aggressive and malignant tumor predominantly affects young adolescent males and typically presents as a large intra-abdominal mass. However, tumor arising from other body sites are also reported in the literature. Histology and immunohistochemistry play an important role in the diagnosis and differentiating this rare tumor from other round cell tumors. A multidisciplinary approach consisting of a combination of surgery, chemotherapy and radiation therapy is the treatment of choice as there is no standard therapy. We report a case of DSRCT of pleura presenting as bilateral pleural effusion in a young adolescent male who was treated with both surgery and chemotherapy. However patient succumbed to death after one year of diagnosis.

A case of bilateral recurrent exudative pleural effusion in a post COVID patient

COVID-19-related pleural effusions are frequently described during the ongoing pandemic. Pleural effusions result from the accumulation of fluid in the pleural space surrounding the lungs. The most common causes of bilateral pleural effusions are due to congestive cardiac failure, nephrotic syndrome, anasarca due to any protein deficiency state or fluid overload, hypothyroidism. Few exudative causes of bilateral pleural effusion also like tuberculosis, primary and metastatic pleural malignancy, bronchogenic Ca, lymphomas, Immunological diseases: Mixed connective tissue disease, long standing cardiac failure or liver failure (on diuretics). Exudative causes of bilateral turbid pleural effusion with recurrent accumulation are very rare without any other associated pathology. The significance of pleural effusions in COVID-19 pneumonia has not been well assessed due to the rarity of the disease limited to case reports/series. A 72-year-old male patient comes to emergency with the complaints increasing shortness of breath for 3 days, Dry cough for same duration, H/O of COVID pneumonia 2 months back with no other comorbidity. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Pleural fluid study reveals exudative hemorrhagic turbid fluid with ADA 71.5 U/L with neutrophilicleukocytosis. Pleural fluid culture reveals moderate growth of pseudomonas species with scanty growth of Candida species. The patient was diagnosed as a case of bilateral complicated recurrent parapneumonic effusion and treated with antibiotic as culture sensitivity with steroids. After 4 times aspiration paracentesis patient was discharged with minimal bilateral pleural effusion. The patient has been followed for 4 months and now he is doing well. Bangladesh J Medicine July 2021; 32(2) : 149-155

Cryptogenic Fibrosing Pleuritis

We report the case of a 46-year-old male patient who was referred for chest pain and bilateral pleural effusion. Despite treatment with antibiotics and steroids, the pleural effusion worsened over a few months until pulmonary function was halved. The CT scan showed bilateral pleural thickening with right basal opacity. Histology revealed extensive fibrotic tissue with focal collections of lymphocytes and giant cells without traces of asbestos bodies. Since no evidence of an infectious, embolic or occupational aetiology was found, this bilateral pleural effusion progressing to diffuse pleural thickening was diagnosed as cryptogenic fibrosing pleuritis, a rare pleural disease.

Bilateral Chylothorax Following Total Thyroidectomy with Neck Dissection for Papillary Thyroid Cancer

Bilateral chylothorax is a rare entity that occurs after a thyroidectomy and neck dissection. This rare condition can lead to severe morbidity, and potentially death, if not managed properly. We report a rare complication of neck surgery and subsequent bilateral pleural effusion, regarding a 35-year-old female who presented at Sultan Qaboos University Hospital in 2018 with shortness of breath and respiratory distress. Particularly, the bilateral pleural effusion and related symptoms occurred one week after a total thyroidectomy with central and left lateral neck dissection. Intraoperative findings, management and literature review will be discussed. Keywords: chylothorax, thyroid cancer, papillary, thyroidectomy, neck dissection, Case report; Oman.