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Subarachnoid Pleural Fistula Due to Penetrating Trauma*: Case Report and Review of the Literature

Christian Lloyd, MD; Steven A. Sahn, MD, FCCP
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*From the Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC.

Correspondence to: Steven A. Sahn, MD, FCCP, Professor of Medicine and Director, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 812, PO Box 250623, Charleston, SC 29425; e-mail: sahnsa@musc.edu



Chest. 2002;122(6):2252-2256. doi:10.1378/chest.122.6.2252
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We describe a case of a 30-year-old man who developed a recurrent pleural effusion after sustaining a gunshot wound to the left side of his chest with subsequent complete paralysis at the T2 level. Subarachnoid-pleural fistulas have rarely been reported as complications of penetrating and blunt trauma, thoracic surgery, as well as spinal surgery. Concomitant injuries may overshadow or complicate the diagnosis of subarachnoid-pleural fistulas. The diagnosis should be considered in any patient with a pleural effusion that is associated with severe neurologic injury, as the fistula rarely heals without surgical intervention and may lead to CNS infection or pneumocephalus.

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