A 25 year old man with known chronic right sided heart failure and ascites due to a congenital heart defect presented with dyspnoea and a massive pleural effusion. Thoracoscopy revealed two diaphragmatic blebs. Changes in peritoneal and thoracic pressure during respiration resulted in periodic squirting of a ruptured bleb, illustrating preferential flow of peritoneal fluid into the thorax. The pleural effusion was successfully treated with drainage of ascitic fluid and chemical pleurodesis.
- pleural effusion
- heart failure
- peritoneopleural fistula
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