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The squirting bleb: image and treatment of inspiration-linked leakage of a peritoneopleural fistula
  1. F H Krouwels2,
  2. P Bresser1
  1. 1Department of Pulmonology, Academic Medical Center, University of Amsterdam, The Netherlands
  2. 2Department of Pulmonology, OLVG Hospital, 1090 HA Amsterdam, The Netherlands
  1. Correspondence to:
    Dr F H Krouwels
    Department of Pulmonology, OLVG Hospital, PO Box 95500, 1090 HA Amsterdam, The Netherlands;


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
  • ascites
  • heart failure
  • peritoneopleural fistula
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