• Frédéric V Valla.
• Pediatric Intensive Care Unit, Debrousse Pediatric University Hospital, Lyon, France. frederic.valla@chu-lyon.fr
• Pediatr Crit Care Me. 2007 Jul 1;8(4):386-8.

ObjectiveTo report a pediatric case of subarachnoid-pleural fistula, its diagnosis, and its treatment.DesignCase report.SettingPediatric intensive care unit.PatientA 9-month-old boy, presenting with severe pleural effusion after posterior chest wall surgery.InterventionsSubarachnoid-pleural fistula was confirmed by isolating beta2-transferrin in the pleural fluid and with magnetic resonance cisternography revealing the location. The patient had a healthy outcome, and the fistula dried without surgery, using positive-pressure ventilation and a chest drain.ConclusionsWe used beta2-transferrin to confirm the diagnosis of clinically suspected subarachnoid-pleural fistula. High-resolution computed tomographic and magnetic resonance cisternography are the best techniques to localize the fistula. The currently recommended treatment is surgery; we suggest that bilevel positive-pressure ventilation, especially with noninvasive techniques, could be a treatment alternative, reducing the flow of cerebral spinal fluid through the fistula and allowing spontaneous closure.

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