Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 2, Number 3, June 2011, pages 115-120

A Pleuroperitoneal Shunt for Interactive Pleural Effusions With Yellow Nail Syndrome


Figure 1.
Figure 1. (a, b) Chest X-ray and chest CT on emergency admission, showing large bilateral pleural effusions. (c) Chest X-ray on emergency admission, showing left side dominant, bilateral pleural effusions. (d) Chest CT showing expanded lungs with a small atelectasis. Bilateral effusions were drained well by the two chest tubes.
Figure 2.
Figure 2. Skin incision on the inframammary line on the midclavicle line and a pararectal transverse skin incision at the umbilicus level on the abdomen.
Figure 3.
Figure 3. Postoperative X-ray findings. (a) Chest X-ray showing the bilateral receiving sites of Denver shunts in both pleural cavities (arrowheads). Pleural effusions were unremarkable. (b) Abdominal X-ray showing the delivery ends of the shunts (arrowheads).
Figure 4.
Figure 4. Denver shunt®. (a) The short tube (receiving site) is installed in the pleural cavity and the long tube (delivery end) is installed in the peritoneal cavity. (b) The pump chamber containing two one-way valves is installed on the chest cage.


Table 1. Characteristics of Reported Cases of Yellow Nail Syndrome With Pleural Effusion Treated Using a Pleuroperitoneal Shunt
CaseYearFirst authorAge (years)SexEffusion (site/shunt site)ComplicationsOutcome
a: English abstract only; b:chylous effusion; lt: left; bil: bilateral; rt: right; BOOP: bronchiolitis obliterans organizing pneumonia
11990Brofman [12]65Flt/ltleg edema, yellow nailreplaced due to obstruction
22004Moorjani [3]75Fbil/billeg edema, yellow nailreplaced due to infection, then patent for 8 years
32005Tanaka [10]70Mbilb/rtgeneral edema, yellow nailreplaced with a pleurovenous shunt
4a2007Katsura [14]56Mbil/rtBOOP, yellow naileffective
52010Present case15Fbil/bilgeneral edema, rhinosinusitis mental retardation, epilepsy, syncopeeffective