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Abstract Details

A Thoracentesis with a Neurological Surprise
General Neurology
P13 - Poster Session 13 (5:30 PM-6:30 PM)
6-003
N/a
This is a 34-year-old female with Neurofibromatosis 1 with a large meningocele in the thoracic cavity misdiagnosed as a pleural effusion.

The patient presented to Pulmonology clinic with three years of progressively worsening dyspnea. Chest x-ray demonstrated left lung collapse. Chest CT to evaluate these chest x-ray findings showed a large cystic lesion in the left hemithorax. She was sent to the emergency department where a thoracentesis was performed with 1 liter of fluid removed. Afterward she developed a headache relieved with supine positioning. Follow-up imaging with chest MRI revealed that the lesion was actually a large meningocele originating from the left T3 neuroforamen. Brain MRI showed diffuse dural enhancement and inferior migration of the midbrain consistent with intracranial hypotension.

On day 10, she underwent a left T2-T3 hemilaminectomy with partial resection of the meningocele, thecal sac repair and lumbar drain placement. Notably the lateral aspect of the pedicle at T2-T3 was eroded. On day 12, the remaining intrathoracic collection was percutaneously drained and a drain was left in the thoracic cavity. The drains were removed by day 17. On day 22, the patient was transferred to Medicine for worsening tachycardia and hypercapneic respiratory failure. CT chest showed interval increase in the meningocele. On day 35, lumbar drain was replaced followed by a lumbar peritoneal shunt on day 40.

About 7 months after discharge, she developed hypoxic respiratory failure secondary to recurrent thoracic meningocele and underwent a thoracotomy with resection and ligation of the meningocele with subsequent improvement in oxygenation. She has since had chronic cervicogenic headaches however her respiratory symptoms have improved.
N/a
N/a
Thoracic meningocele is uncommon in the workup for pleural effusion, however in patients with neurofibromatosis, it should be in the differential and evaluated with imaging prior to thoracentesis.
Authors/Disclosures
Sakinah Sabadia, MD (NYU)
PRESENTER 		Dr. Sabadia has nothing to disclose.
Kaleb H. Yohay, MD (NYU Langone Medical Center) Dr. Yohay has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Dr. Yohay has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Yohay has received publishing royalties from a publication relating to health care.