Journal of Pediatric Neurosciences
LETTER TO THE EDITOR
Year
: 2017  |  Volume : 12  |  Issue : 1  |  Page : 117--118

A rare cause of pleural effusion; cerebrospinal fluid leakage


Mehmet Alakaya1, Ali Ertug Arslankoylu1, Esra Vatansever Danaci1, Hakan Ozalp2, Anıl Ozgur3, Caner Ispir4,  
1 Department of Pediatric Intensive Care Unit, Faculty of Medicine, Mersin University, Mersin, Turkey
2 Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
3 Department of Radiology, Faculty of Medicine, Mersin University, Mersin, Turkey
4 Department of Pediatric Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey

Correspondence Address:
Mehmet Alakaya
Department of Pediatric Intensive Care Unit, Faculty of Medicine, Mersin University, Mersin
Turkey




How to cite this article:
Alakaya M, Arslankoylu AE, Danaci EV, Ozalp H, Ozgur A, Ispir C. A rare cause of pleural effusion; cerebrospinal fluid leakage.J Pediatr Neurosci 2017;12:117-118


How to cite this URL:
Alakaya M, Arslankoylu AE, Danaci EV, Ozalp H, Ozgur A, Ispir C. A rare cause of pleural effusion; cerebrospinal fluid leakage. J Pediatr Neurosci [serial online] 2017 [cited 2022 May 25 ];12:117-118
Available from: https://www.pediatricneurosciences.com/text.asp?2017/12/1/117/205645


Full Text



Dear Sir,

Although firearm injuries are rare among penetrating traumas in children, they are very important in terms of their complications. Many thoracic complications may arise during spinal trauma caused by gunshot wounds.[1] Cerebrospinal fluid (CSF) leak is one of the serious complications of gunshot wounds.[1] Here, we present a 10-year-old girl admitted to our Pediatric Intensive Care Unit with spinal trauma after being shot on the shoulder.

She was admitted in critical condition. The patient's Glasgow Coma Score was six with hemiplegia in her legs. She had anisocoria and reduced lung sounds on the left side of the chest. She was intubated and stabilized in Pediatric Intensive Care Unit. Chest tube inserted because of pneumothorax and hemothorax in the left lung. The entry hole of the bullet was in the left shoulder, and the exit hole was in the interscapular region. In computerized tomography of the chest, there was partial fracture in T2, T3, and T4 vertebrae [Figure 1] and almost complete transection in magnetic resonance images (MRIs) of the spinal cord [Figure 2]. Horner's syndrome was detected on the left ophthalmologic examination. During the follow-up, hemothorax improved, but serious pleural effusion persisted in the thorax tube. Pleural fluid sample was found to be compatible with CSF. MRI was done to evaluate the possible CSF leakage. MRI showed a fistula at T2 level and a fluid collection with air intensities extending from the left laminae to the apex of the lung [Figure 3]. The dura mater defect at T2 level was repaired with a 7.5 cm × 7.5 cm graft by neurosurgery. After the operation, the amount of fluid draining from the thorax tube reduced gradually and ceased. The thorax tube was removed. The patient was extubated and discharged.{Figure 1}{Figure 2}{Figure 3}

As a result, the indication of the surgery is limited in the penetrant injuries of the spinal cord. The aim of the surgical treatment is to prevent complications such as infection, CSF fistula, and spinal instability.[2] However, in patients with spinal trauma due to gunshot, it should be kept in mind that the pleural effusion may be related to the CSF leakage. The patients with pleural effusion should be evaluated for possible cerebrospinal leakage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1McKinley WO, Johns JS, Musgrove JJ. Clinical presentations, medical complications, and functional outcomes of individuals with gunshot wound-induced spinal cord injury. Am J Phys Med Rehabil 1999;78:102-7.
2Jakoi A, Iorio J, Howell R, Zampini JM. Gunshot injuries of the spine. Spine J 2015;15:2077-85.