Dyspnoea due to spinal subarachnoid-pleural fistula.

We report a case of a 72-year-old woman who underwent transthoracic discectomy for a giant disc herniation at T9-T10 level causing significant cord compromise. Following removal of her non-suction chest drain, she was transferred to the acute spinal-orthogeriatric unit where she was under regular review by elderly care physicians as part of their spinal liaison role. Approximately four weeks after the operation, she started becoming dyspnoeic and her chest X-ray showed moderate left-sided pleural effusion which tested positive for β2-transferrin, a sensitive marker of cerebrospinal fluid, supporting a diagnosis of subarachnoid-pleural fistula. This is a very unusual cause of breathlessness in a postoperative patient.