{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:47:24Z","timestamp":1782283644107,"version":"3.54.5"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous nephrolithotomy (PCNL) may cause severe thoracic and abdominal complications. Because their onset can be insidious and their intraoperative manifestations atypical, recognition may be delayed. We report a case of sudden bilateral hemorrhagic pleural effusion with hemorrhagic ascites during PCNL and discuss strategies for intraoperative identification and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 63-year-old woman underwent PCNL for multiple right renal calculi. During the procedure, renal pelvic bleeding occurred, followed by a sudden increase in airway pressure to 40 cmH2O, a decrease in oxygen saturation to 92\u201395%, and a fall in blood pressure to 78\/59\u202fmmHg. Bedside ultrasound revealed substantial bilateral pleural effusion and moderate intraperitoneal fluid accumulation. Emergency bilateral chest tube drainage and abdominal paracentesis were performed, evacuating a large volume of pale red blood-tinged fluid. After volume expansion, blood transfusion, and vasopressor support, the patient\u2019s vital signs stabilized. She was discharged after 10\u202fdays of recovery, and the 3-month follow-up showed no significant abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>During PCNL, sudden hypoxemia and elevated airway pressure should prompt immediate assessment for severe pleural or peritoneal effusion. In this case, the findings may have resulted from pressure-related communication between the abdominal and thoracic cavities, with fluid translocation through small diaphragmatic defects into both pleural spaces. Bedside ultrasound can serve as a first-line screening tool during PCNL. Continuous ultrasound monitoring, including wearable devices, may offer advantages in prone-position surgery, particularly when ongoing surveillance for pulmonary complications is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1895920","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:56:16Z","timestamp":1782280576000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Simultaneous bilateral hemorrhagic pleural effusion and hemorrhagic ascites during percutaneous nephrolithotomy: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Haobin","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxin","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weilin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajun","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianping","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manli","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shunde Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine","place":["Foshan, Guangdong, 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