- Email: [email protected]
Pneumopericardium following Laparoscopy
ously shown (Fig 2) demonstrating a right lower lobe A-V fistula. DISCUSSION
The results in this patient show the value of the shunt measurement at high lung volume compared to FRC In the diagnosis and follow-up of A-V fistulas. The theoretical basis for the increased shunt at TLC is the increased pulmonary vascular resistance that occurs with inflation to a high lung volume.v" This effect is even greater in the hypoxic state.t Another reason is the stretching of vessels by the surrounding expanding lung at high lung volumes (pulmonary interdependence). Most A-V fistulas are situated in subpleural areas and are subject to distension by the expanding parenchyma and would accept a greater blood Bow. 15 In the patients described by Huseby et al,! the technique was used to identify or confirm the presence of fistulas in a qualitative manner. We have utilized this technique for evaluation before and after surgical excision of A-V fistulas. The treatment of A-V fistulas has been controversial. From his review of 63 cases at the Mayo Clinic, Dines et ale recommended that surgical excision be recommended for patients with symptoms (especially hemoptysis), roentgenographic evidence of enlargement, single lesions associated with hereditary telangiectasis, and fistulas fed by a systemic arterial supply (3 of 63 in his series). Other authorst-" have recommended that all be removed because of the danger of brain abscess. Hodgson and Kaye" suggested the removal of as little parenchyma as possible, because theoretically, the increased flow might dilate smaller fistulas already present. The presentation of A-V fistulas with a brain abscess has been well described.t" In our patient, the removal of both the abscess and the fistulas has prevented further problems for a period of 18 months. The TLC-FRC arterial blood gas evaluation is useful in documenting AV fistulas in the lung and for following a patient postoperatively to assess any further A-V fistula progression or development.
REFERENCES 1 Huseby JS, Culver BH, Butler J: Pulmonary arteriovenous fistulas: Increase in shunt at high lung volume. Am Rev Respir Dis 115:229, 1977 2 Thomas LJ, Griffo ZJ, Roos A: Effect of negative-pressure inflation of the lung on pulmonary vascular resistance. J Appl PhysioI16:451, 1961 3 Howell JBL, Permutt S, Proctor DF, et al: Effect of inflation of the lung on different parts of pulmonary vascular bed. J Appl Physiol, 16:71, 1961 4 Quebbeman EJ, Dawson CA: Effect of lung inflation and hypoxia on pulmonary arterial blood volume. J Appl PhysioI43:8, 1977 5 Anabtawi IN, Ellison RG, Ellison LT: Pulmonary arteriovenous fistulas: Anatomical variations, embryology, and classi6cation. Ann Thorac Surg 1:277, 1965 6 Dines DE, Arms RA, Bematz PE, et al: Pulmonary arteriovenous fistulas. Mayo CIin Proc 49:460, 1974 7 Thompson RL, Cattaneo SM, Bames J: Recurrent brain abscess: Manifestation of pulmonary arteriovenous fistulas
CHEST, 76: 5, NOVEMBER, 1979
and hereditary hemorrhagic telangiectasia. Chest 72: 654
1~7
'
8 Moyer JB, Glantz C, Brest AW: Pulmonary arteriovenous fistulas: Physiologic and clinical considerations. Am J Med
32:417,1962 9 Hodgson CH, Kaye RL: Pulmonary arteriovenous fistulas and hereditary hemorrhagic telangiectasia: A review and report of 35 cases of fistula. Dis Chest 43:449, 1963 10 Meacham WF, Scott HW: Congenital pulmonary arteriovenous aneurysm complicated by bacteroides abscess of brain: Successful surgical management. AnD 8urg 147: 405, 1958
Pneumopericardium following Laparoscopy* R. Derek Nicholscm, M.D., and Neil D. BermtJn, M.D. There have been no published reports of pneumopericardium compUcatiDglaparoscopy. Following an ap....• enfly uncompllcated laparoscopy, a 35·year-old woman developed pneumopericardium associated with subcu· taneous emphysema of the neck. 11Iis resolved without spedftc thenpy and without sequelae.
L aparoscopy has gained widespread acceptance gynecologic surgery because of its efficiency, both in
as a diagnostic and therapeutic tool, coupled with a low morbidity.I-9 As with other innovations, potential complications become increasingly apparent as the frequency of usage increases. 1 Although there are numerous variations in laparoscopic techniques, basic to all is the introduction of some form of pneumoperitoneum and this is the source of many complications. 6, 7 Although subcutaneous, preperitoneal, omental and mediastinal emphysema have been described,1-6 to our knowledge pneumopericardium has not been documented previously. This report deals with a patient who developed pneumopericardium and subcutaneous emphysema following an otherwise uncomplicated laparoscopic procedure. CASE REPORT
A 35-year-old woman was admitted for a laparoscopic tubal coagulation. Physical examination was unremarkable. There was a soft systolic ejection murmur along the left sternal border. Under general endotracheal anesthesia, in the dorsolithotomy position, Iaparoscopy was performed using a Veress needle and insuftlation with 5 liters of carbon dioxide. Good visualization was obtained and the pelvic organs were normal. A coagulation electrode was introduced through a second incision above the pubis and the fa1lopian tubes were coagulated. The abdomen was desufBated and the incisions closed. The total duration of anesthesia was 45 minutes. The -From the Division of Cardiology, Department of Medicine and the Department of Obstetrics ana Gynecology Toronto Western Hospital and the University of Toronto'Toronto Canada. ' , Reprint reque8t8: Dr. Bemum, 25 Leontml Avenue Toronto Ontario M5T2R2 ' ,
PNEUMOPERICARDIUM FOLLOWING LAPAROSCOPY •
loud pericardial "crunch" was heard coincident with the heart rate. Blood pressure, pulse rate and venous pressure were normal. An ECG was normal. X-ray films of the chest (Fig 1) and the soft tissues of the neck (Fig 2) documented the presence of pneumopericardium and surgical emphysema involving the soft tissues of the mediastinum and neclc. There was no evidence of pneumothorax. The patient was kept in hospital for the next three days. Vital signs were monitored and remained stable. The patient was treated with analgesics. She was discharged on the fourth postoperative day. Her examination at the time was similar to that prior to surgery except for some crepitations localizedto the subcutaneous tissue above the clavicles. DISCUSSION
FIGURE 1. Chest x-ray fUm, posteroanterior projection; lowest tmOW on either side indicates subdiaphragmatic air; remaining tmOW8 point to air outlining the pericardial cavity.
procedure was apparently free of complicatioos and the patient was apparently well when transferred to the recovery room.
That evening, about six hours after the procedure, the patient complained of chest pain. There were crepitations in the subcutaneous tissue of the neck and upper anterior chest, but not in the anterior abdominal wall On auscultation, a
2. X-ray fllm of neclc in anterior projection showing air in the tissue planes and in the subcutaneous tissues above
FiGURE
the left clavicle.
•
NICHOLSON, BERMAN
Subcutaneous emphysema has been reported to occur in from 0.2 6 to 122 per 1,000 laparoscopies. The mechanism is presumed to be accidental movement of the trocar sleeve so that the insufHating ports at the tip end up in the properitoneal space. From there the gas can dissect cephalad into the mediastinum. This does not appear to have been the mechanism in this case, as the abdominal wall was never noted to be involved with emphysema. The gas may have passed through one or other of the gaps in the diaphragm and into the mediastinum and pericardium. From here, the gas tracked into the soft tissues of the neck and subsequently, because of the patient's supine position postoperatively, into the tissues of the anterior chest wall. In the embryo, the pericardial and peritoneal cavities communicate'? and it may be that the patient had a congenital deficiency of part of the membraneous portion of the diaphragm. However, congenital pericardial defects that have been described pathologically have invariably communicated with a pleural cavity.ll There was no evidence of pneumothorax in our patient. At one point during the procedure, while the peritoneal cavity was still insufHated, the patient coughed. It is conceivable that the resultant changes in intrathoracic and intra-abdominal pressures at this time forced some air through a diaphragmatic hiatus most likely around the inferior vena cava, and that this air slowly moved upward becoming manifest some several hours postoperatively. Although tension pneumopericardium has been described as producing the syndrome of cardiac tamponade,12,13 this has always been in a setting where there has been a continued exposure to air under pressure either due to mechanical ventilation or a tension pneumonthorax. 12,13 In the absence of associated fluid, air in the pericardial space that is not under high pressure does not produce any evidence of hemodynamic embarrassment because of the compressibility of the air as compared to fluid.14 Thus, pneumopericardium appears to be a rare complication of laparoscopy which may result in a prolongation of the patient's hospital stay, but is unlikely to have more significant consequences. ACKNOWLEDGMENT: The authors would like to thank M. McKenzie and C. Vita for secretarial assistance.
CHEST, 76: 5, NOVEMBER, 1979
1 Soderstrom HM, Butler JC: A critical evaluation of complications in laparoscopy. J Reprod Moo 10:245·248, 1973 2 Kleppinger RK : One thousand laparoscopies at a community hospital. J Reprod Moo 13:13-20, 1974 3 Phillips J, Keith D, Keith L:' Gynecologic laparoscopy 1973: The state of the Art. J Reprod Moo 12:215·221, 1974 4 Steptoe P: Gynecological laparoscopy. J Reprod Med 10:211-226, 1973 5 Abn YW, Leach JA: A comparison of subcutaneous and periperitoneal emphysema arising from gynecologic laparoscopic procedures. J Reprod Med 17:335-337, 1976 6 Hulka JF, Soderstrom RM, Corson SL, et al: Complications committee of the American Association of Gynecologic Laparoscopists: First annual report. J Reprod Moo 10:301-306, 1973 7 Cibils LA: Gynecologic Laparoscopy : Diagnostic and Operatory. Philadelphia, Lea & Febiger 1975, pp 50-51 8 Levinson CJ: Laparoscopy : report of 500 consecutives cases. Wis Med J 72:141-144, 1973 9 Imran M, Yashari M, Slate WG : Laparoscopy and some of its hazards . Del Med J 48:71-76,1976 10 Langman J: Medical Embryology. Baltimore, Williams and Wilkins 1963 pp 235-237 11 Hudson REB: Cardiovascular Pathology (Vol 2). London, Arnold, 1965, pp 1535-1538 12 McCaughey W, King R: Pneumopericardium associated with tracheal rupture. Anaesth. 30:199-205,1975 13 Westaby S: Pneumopericardium and tension pneumopericardium after closed-chest injury. Thorax 32:91-97, 1977 14 Rosen A, Vandagna J, Jamplis RW: Spontaneous pneumopericardium. Am Rev Respir Dis 87:764·765, 1963
10 -23 78
11 07 78 FxGURE
Bloody Pleural Effusion with Sarcoidosis *
In
a Patient
Paul De Vuylt, M.D.; Andre De Troyer, MD.; and ]ean-Claude Yemault, M.D., F.C.C.P.
A 50-year-old man was evaluated for pleuritic pain. Chest roentgenogram showed cWfuse parenchymal illfiltrates aad bilateral pleural effusion that, oa tIIoncocentesis, was found to be a bloody fluid. Biopsy of paratracbeaI nodes demonstrated llbundut IlOIlaIlIle8tiq p1UIulomas consisteat witIa lIlII'COidosis. PredailloIle therapy resulted in rapid diIappearanc:e of the pleural etfasIon, pl'Op'eslive clearing of parenchymal bIDrates, ... marked bnprovemeat of ptdmonary fuadioB testB. Sercoidosls sllOIIhI lie iad8ded in the Merelttilll _ .
1. The AP views of chest before (top) , and after
(bottom) ten days of steroid therapy.
to heart failure or coincidental disease. 1 , 2 Several recent reports, however, suggest that noncaseating granulomas, typical of sarcoidosis, can also involve the pleura, as demonstrated by pleural biopsies, thoracotomy, or Table l-l'ullnDncP'Y FURdion Tat. Rea..".
Before Predicted Therapy
After Therapy
VC, liter
5.23
2.65
3.95
FRC,liter
4.05
3.83
3.82
TLC, liter
7.31
5.78
6.43
FEVi/VC, percent
>70
70
71
TLco, ml/mm Hgfmin
31.3
20.75
0.325
0.174
0.261
28.2
50.0
39.1
IlOIlis of bloody pie.........OIL
CL, liter/em H,o
Dleural effusion was classically considered as a rare
Pst(L) at TCL, em HtO
-From the Chest Service, Erasme University Hospital, Brussels School of Medicine, Brussels, Belgium. Reprint requests: Dr. De Troyer, Et'tJSme Unwemtl/ H06fJital, 808 Rte de Lennick, B1070 BftlSsels, Belgmm.
Abbreviations: VC indicates vital capacity; FRC, functional residual capacity; TLC, total lung capacity; FEV., forced expiratory volume in 1 sec; TLco, CO transfer factor; CL, expiratory lung compliance; and Pst(L), static recoil pressure of the lung.
C event in sarcoidosis and generally thought to be due
CHEST, 76: 5, NOVEMBER, 1979
BLOODY PLEURAL EFFUSION AND SARCOIDOSIS 607
The results in this patient show the value of the shunt measurement at high lung volume compared to FRC In the diagnosis and follow-up of A-V fistulas. The theoretical basis for the increased shunt at TLC is the increased pulmonary vascular resistance that occurs with inflation to a high lung volume.v" This effect is even greater in the hypoxic state.t Another reason is the stretching of vessels by the surrounding expanding lung at high lung volumes (pulmonary interdependence). Most A-V fistulas are situated in subpleural areas and are subject to distension by the expanding parenchyma and would accept a greater blood Bow. 15 In the patients described by Huseby et al,! the technique was used to identify or confirm the presence of fistulas in a qualitative manner. We have utilized this technique for evaluation before and after surgical excision of A-V fistulas. The treatment of A-V fistulas has been controversial. From his review of 63 cases at the Mayo Clinic, Dines et ale recommended that surgical excision be recommended for patients with symptoms (especially hemoptysis), roentgenographic evidence of enlargement, single lesions associated with hereditary telangiectasis, and fistulas fed by a systemic arterial supply (3 of 63 in his series). Other authorst-" have recommended that all be removed because of the danger of brain abscess. Hodgson and Kaye" suggested the removal of as little parenchyma as possible, because theoretically, the increased flow might dilate smaller fistulas already present. The presentation of A-V fistulas with a brain abscess has been well described.t" In our patient, the removal of both the abscess and the fistulas has prevented further problems for a period of 18 months. The TLC-FRC arterial blood gas evaluation is useful in documenting AV fistulas in the lung and for following a patient postoperatively to assess any further A-V fistula progression or development.
REFERENCES 1 Huseby JS, Culver BH, Butler J: Pulmonary arteriovenous fistulas: Increase in shunt at high lung volume. Am Rev Respir Dis 115:229, 1977 2 Thomas LJ, Griffo ZJ, Roos A: Effect of negative-pressure inflation of the lung on pulmonary vascular resistance. J Appl PhysioI16:451, 1961 3 Howell JBL, Permutt S, Proctor DF, et al: Effect of inflation of the lung on different parts of pulmonary vascular bed. J Appl Physiol, 16:71, 1961 4 Quebbeman EJ, Dawson CA: Effect of lung inflation and hypoxia on pulmonary arterial blood volume. J Appl PhysioI43:8, 1977 5 Anabtawi IN, Ellison RG, Ellison LT: Pulmonary arteriovenous fistulas: Anatomical variations, embryology, and classi6cation. Ann Thorac Surg 1:277, 1965 6 Dines DE, Arms RA, Bematz PE, et al: Pulmonary arteriovenous fistulas. Mayo CIin Proc 49:460, 1974 7 Thompson RL, Cattaneo SM, Bames J: Recurrent brain abscess: Manifestation of pulmonary arteriovenous fistulas
CHEST, 76: 5, NOVEMBER, 1979
and hereditary hemorrhagic telangiectasia. Chest 72: 654
1~7
'
8 Moyer JB, Glantz C, Brest AW: Pulmonary arteriovenous fistulas: Physiologic and clinical considerations. Am J Med
32:417,1962 9 Hodgson CH, Kaye RL: Pulmonary arteriovenous fistulas and hereditary hemorrhagic telangiectasia: A review and report of 35 cases of fistula. Dis Chest 43:449, 1963 10 Meacham WF, Scott HW: Congenital pulmonary arteriovenous aneurysm complicated by bacteroides abscess of brain: Successful surgical management. AnD 8urg 147: 405, 1958
Pneumopericardium following Laparoscopy* R. Derek Nicholscm, M.D., and Neil D. BermtJn, M.D. There have been no published reports of pneumopericardium compUcatiDglaparoscopy. Following an ap....• enfly uncompllcated laparoscopy, a 35·year-old woman developed pneumopericardium associated with subcu· taneous emphysema of the neck. 11Iis resolved without spedftc thenpy and without sequelae.
L aparoscopy has gained widespread acceptance gynecologic surgery because of its efficiency, both in
as a diagnostic and therapeutic tool, coupled with a low morbidity.I-9 As with other innovations, potential complications become increasingly apparent as the frequency of usage increases. 1 Although there are numerous variations in laparoscopic techniques, basic to all is the introduction of some form of pneumoperitoneum and this is the source of many complications. 6, 7 Although subcutaneous, preperitoneal, omental and mediastinal emphysema have been described,1-6 to our knowledge pneumopericardium has not been documented previously. This report deals with a patient who developed pneumopericardium and subcutaneous emphysema following an otherwise uncomplicated laparoscopic procedure. CASE REPORT
A 35-year-old woman was admitted for a laparoscopic tubal coagulation. Physical examination was unremarkable. There was a soft systolic ejection murmur along the left sternal border. Under general endotracheal anesthesia, in the dorsolithotomy position, Iaparoscopy was performed using a Veress needle and insuftlation with 5 liters of carbon dioxide. Good visualization was obtained and the pelvic organs were normal. A coagulation electrode was introduced through a second incision above the pubis and the fa1lopian tubes were coagulated. The abdomen was desufBated and the incisions closed. The total duration of anesthesia was 45 minutes. The -From the Division of Cardiology, Department of Medicine and the Department of Obstetrics ana Gynecology Toronto Western Hospital and the University of Toronto'Toronto Canada. ' , Reprint reque8t8: Dr. Bemum, 25 Leontml Avenue Toronto Ontario M5T2R2 ' ,
PNEUMOPERICARDIUM FOLLOWING LAPAROSCOPY •
loud pericardial "crunch" was heard coincident with the heart rate. Blood pressure, pulse rate and venous pressure were normal. An ECG was normal. X-ray films of the chest (Fig 1) and the soft tissues of the neck (Fig 2) documented the presence of pneumopericardium and surgical emphysema involving the soft tissues of the mediastinum and neclc. There was no evidence of pneumothorax. The patient was kept in hospital for the next three days. Vital signs were monitored and remained stable. The patient was treated with analgesics. She was discharged on the fourth postoperative day. Her examination at the time was similar to that prior to surgery except for some crepitations localizedto the subcutaneous tissue above the clavicles. DISCUSSION
FIGURE 1. Chest x-ray fUm, posteroanterior projection; lowest tmOW on either side indicates subdiaphragmatic air; remaining tmOW8 point to air outlining the pericardial cavity.
procedure was apparently free of complicatioos and the patient was apparently well when transferred to the recovery room.
That evening, about six hours after the procedure, the patient complained of chest pain. There were crepitations in the subcutaneous tissue of the neck and upper anterior chest, but not in the anterior abdominal wall On auscultation, a
2. X-ray fllm of neclc in anterior projection showing air in the tissue planes and in the subcutaneous tissues above
FiGURE
the left clavicle.
•
NICHOLSON, BERMAN
Subcutaneous emphysema has been reported to occur in from 0.2 6 to 122 per 1,000 laparoscopies. The mechanism is presumed to be accidental movement of the trocar sleeve so that the insufHating ports at the tip end up in the properitoneal space. From there the gas can dissect cephalad into the mediastinum. This does not appear to have been the mechanism in this case, as the abdominal wall was never noted to be involved with emphysema. The gas may have passed through one or other of the gaps in the diaphragm and into the mediastinum and pericardium. From here, the gas tracked into the soft tissues of the neck and subsequently, because of the patient's supine position postoperatively, into the tissues of the anterior chest wall. In the embryo, the pericardial and peritoneal cavities communicate'? and it may be that the patient had a congenital deficiency of part of the membraneous portion of the diaphragm. However, congenital pericardial defects that have been described pathologically have invariably communicated with a pleural cavity.ll There was no evidence of pneumothorax in our patient. At one point during the procedure, while the peritoneal cavity was still insufHated, the patient coughed. It is conceivable that the resultant changes in intrathoracic and intra-abdominal pressures at this time forced some air through a diaphragmatic hiatus most likely around the inferior vena cava, and that this air slowly moved upward becoming manifest some several hours postoperatively. Although tension pneumopericardium has been described as producing the syndrome of cardiac tamponade,12,13 this has always been in a setting where there has been a continued exposure to air under pressure either due to mechanical ventilation or a tension pneumonthorax. 12,13 In the absence of associated fluid, air in the pericardial space that is not under high pressure does not produce any evidence of hemodynamic embarrassment because of the compressibility of the air as compared to fluid.14 Thus, pneumopericardium appears to be a rare complication of laparoscopy which may result in a prolongation of the patient's hospital stay, but is unlikely to have more significant consequences. ACKNOWLEDGMENT: The authors would like to thank M. McKenzie and C. Vita for secretarial assistance.
CHEST, 76: 5, NOVEMBER, 1979
1 Soderstrom HM, Butler JC: A critical evaluation of complications in laparoscopy. J Reprod Moo 10:245·248, 1973 2 Kleppinger RK : One thousand laparoscopies at a community hospital. J Reprod Moo 13:13-20, 1974 3 Phillips J, Keith D, Keith L:' Gynecologic laparoscopy 1973: The state of the Art. J Reprod Moo 12:215·221, 1974 4 Steptoe P: Gynecological laparoscopy. J Reprod Med 10:211-226, 1973 5 Abn YW, Leach JA: A comparison of subcutaneous and periperitoneal emphysema arising from gynecologic laparoscopic procedures. J Reprod Med 17:335-337, 1976 6 Hulka JF, Soderstrom RM, Corson SL, et al: Complications committee of the American Association of Gynecologic Laparoscopists: First annual report. J Reprod Moo 10:301-306, 1973 7 Cibils LA: Gynecologic Laparoscopy : Diagnostic and Operatory. Philadelphia, Lea & Febiger 1975, pp 50-51 8 Levinson CJ: Laparoscopy : report of 500 consecutives cases. Wis Med J 72:141-144, 1973 9 Imran M, Yashari M, Slate WG : Laparoscopy and some of its hazards . Del Med J 48:71-76,1976 10 Langman J: Medical Embryology. Baltimore, Williams and Wilkins 1963 pp 235-237 11 Hudson REB: Cardiovascular Pathology (Vol 2). London, Arnold, 1965, pp 1535-1538 12 McCaughey W, King R: Pneumopericardium associated with tracheal rupture. Anaesth. 30:199-205,1975 13 Westaby S: Pneumopericardium and tension pneumopericardium after closed-chest injury. Thorax 32:91-97, 1977 14 Rosen A, Vandagna J, Jamplis RW: Spontaneous pneumopericardium. Am Rev Respir Dis 87:764·765, 1963
10 -23 78
11 07 78 FxGURE
Bloody Pleural Effusion with Sarcoidosis *
In
a Patient
Paul De Vuylt, M.D.; Andre De Troyer, MD.; and ]ean-Claude Yemault, M.D., F.C.C.P.
A 50-year-old man was evaluated for pleuritic pain. Chest roentgenogram showed cWfuse parenchymal illfiltrates aad bilateral pleural effusion that, oa tIIoncocentesis, was found to be a bloody fluid. Biopsy of paratracbeaI nodes demonstrated llbundut IlOIlaIlIle8tiq p1UIulomas consisteat witIa lIlII'COidosis. PredailloIle therapy resulted in rapid diIappearanc:e of the pleural etfasIon, pl'Op'eslive clearing of parenchymal bIDrates, ... marked bnprovemeat of ptdmonary fuadioB testB. Sercoidosls sllOIIhI lie iad8ded in the Merelttilll _ .
1. The AP views of chest before (top) , and after
(bottom) ten days of steroid therapy.
to heart failure or coincidental disease. 1 , 2 Several recent reports, however, suggest that noncaseating granulomas, typical of sarcoidosis, can also involve the pleura, as demonstrated by pleural biopsies, thoracotomy, or Table l-l'ullnDncP'Y FURdion Tat. Rea..".
Before Predicted Therapy
After Therapy
VC, liter
5.23
2.65
3.95
FRC,liter
4.05
3.83
3.82
TLC, liter
7.31
5.78
6.43
FEVi/VC, percent
>70
70
71
TLco, ml/mm Hgfmin
31.3
20.75
0.325
0.174
0.261
28.2
50.0
39.1
IlOIlis of bloody pie.........OIL
CL, liter/em H,o
Dleural effusion was classically considered as a rare
Pst(L) at TCL, em HtO
-From the Chest Service, Erasme University Hospital, Brussels School of Medicine, Brussels, Belgium. Reprint requests: Dr. De Troyer, Et'tJSme Unwemtl/ H06fJital, 808 Rte de Lennick, B1070 BftlSsels, Belgmm.
Abbreviations: VC indicates vital capacity; FRC, functional residual capacity; TLC, total lung capacity; FEV., forced expiratory volume in 1 sec; TLco, CO transfer factor; CL, expiratory lung compliance; and Pst(L), static recoil pressure of the lung.
C event in sarcoidosis and generally thought to be due
CHEST, 76: 5, NOVEMBER, 1979
BLOODY PLEURAL EFFUSION AND SARCOIDOSIS 607