IATROGENIC CEREBROSPINAL-FLUID FISTULA TO THE PLEURAL CAVITY - CASE-REPORT AND LITERATURE-REVIEW

THE AUTHORS OBSERVED one case of an iatrogenic subarachnoid-pleural fi stula secondary to the resection of an upper lobe carcinoma of the lun g. The clinical presentation was characterized by a sudden deteriorati on of mental status and level of consciousness immediately after the r emoval of the thoracotomy chest tube. The diagnosis was substantiated by the demonstration of pneumocephalus by a computed tomographic scan of the head and by the identification of a left T5 nerve root fistula by a postmyelographic computed tomographic scan. The excellent anatomi cal definition achieved by this modality emphasizes its usefulness in the identification and therapeutic management of these lesions. Operat ive treatment consisted of the suture ligature of the nerve root and a chest drain. The postoperative course was uneventful, and the outcome was excellent, with the only finding of sensory loss in the T5 nerve root territory. A review of the literature disclosed 11 similar cases, with some differences in the choice of the most appropriate diagnosti c procedure and significant differences in the therapeutic options, wh ich were related to the various mechanisms of injury.