Traumatic subarachnoid-pleural fistula: case report and review of the literature.

Subarachnoid-pleural fistula is an unusual complication of spinal cord injury without radiologic abnormality (SCIWORA) and a rare cause of posttraumatic pleural effusion. The clinical presentation and surgical management of a child, the first with this complication seen at our institution, who sustained a T-6 SCIWORA and a cerebrospinal fluid-pleural effusion following a pedestrian-motor vehicle collision is discussed. Magnetic resonance imaging (MRI) proved superior to myelography in demonstrating the fistulous connection and associated cord damage. The fistula was successfully closed via a thoracotomy using a muscle and pleural plug.