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PubMed1999

Congenital chylothorax in neonatal thyrotoxicosis.

We report a patient with congenital chylothorax who also had neonatal thyrotoxicosis secondary to maternal Graves' disease. Fetal tachycardia with hydrops was detected at 28 weeks' gestational age. The fetus responded to antithyroid medication in utero but had persistent bilateral pleural effusion. At birth, he had respiratory distress due to massive pleural effusion. Cytologic studies of pleural fluid were consistent with chylothorax. To the best of our knowledge, the association of congenital chylothorax with fetal (neonatal) thyrotoxicosis, has not been reported previously.

Adult↗
PubMedDate not supplied

Use of omentum as a physiologic drain for treatment of chylothorax in a dog.

OBJECTIVES: To describe a novel technique for the surgical treatment of idiopathic chylothorax in a dog. ANIMALS: A 6-year-old, male Rhodesian Ridgeback, which presented with a history of reduced exercise tolerance and dyspnea. METHODS: Idiopathic chylothorax was diagnosed. Intermittent pleural drainage failed to resolve the problem. During surgery, extensive pleural fibrosis made it impossible to identify the thoracic duct. A dorsal omental pedicle was advanced through an incision in the diaphragm and into the cranial thoracic cavity to act as a physiological drain. RESULTS: The dog recovered well and has remained free from clinical signs of recurrence of the effusion (16 months at the time of writing). CONCLUSIONS: The disease-free interval achieved in this dog indicates that this novel technique is worthy of further consideration in the management of idiopathic chylothorax.

Animals↗
PubMed1994

Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication.

The incidence of chylothorax after pleuro-pulmonary operations as well as its treatment is reported. Of 1744 operations performed postoperative chylothorax developed in 13 (0.74%). It resulted in two cases from the transection of the thoracic duct, in six from the transection of the so-called minor lymph channels, which drain lymph from mediastinal nodes straight into the thoracic duct or drain lung segments into the thoracic duct via the pulmonary ligament; the transection of these channels occurred during mediastinal lymphadenectomy or during the section of the pulmonary ligament. In 5 patients the site of leakage was not determined as reoperation was not required. Conservative treatment with low-fat diet and medium-chain triglycerides and/or total parenteral nutrition was attempted in all but one patient but was successful only in 5 cases whose mean losses were 292 ml/day. Seven patients were reoperated after a mean of 11 days; their mean losses were 930 ml/day. One patient was reoperated on the third postoperative day without attempting conservative treatment; his mean loss was 850 ml/day. Lymphadenectomy seems to be an important risk factor for postoperative chylothorax. Chyle leakage around 500 ml/day or higher that tends to decrease below 500 ml/day after a few days of dietary manipulation usually stops within 10-20 days, while leakage over 500 ml/day that does not tend to decrease below 500 ml/day seldom if ever stops without surgery, so that a more aggressive attitude is justified.

Adult↗
PubMed1983

Treatment of postsurgical chylothorax with fibrin glue.

The treatment of postsurgical chylothorax with fibrin glue is reported. Chylothorax developed in a 3 1/2-month-old infant 2 days after extrapleural ligation of a patent ductus arteriosus. At rethoracotomy the chyle leak could not be located. To stop chyle effusion, the region of the presumed leakage was sealed with fibrin glue and a pleural flap. It is suggested that early reoperation and closure of the chyle leak with fibrin adhesive should be considered in cases of postsurgical chylothorax in infants.

Chylothorax↗
PubMed1984

Combined chylopericardium and chylothorax after total correction of Fallot's tetralogy.

Chylothorax as a complication of cardiovascular surgery has a reported incidence of lower than 0.5% and is extremely rare following intrapericardial procedures. Chylopericardium in particular has a reported incidence even lower than that of chylothorax. The origin of these complications is, in either case, a direct injury to the thoracic duct or a thrombosis at the junction of the left jugular and subclavian veins obstructing thoracic duct drainage and, finally, injury to the anterior mediastinum lymphatics in the thymus area. A case is presented where chylopericardium occurred in combination with chylothorax after operation for total correction of Fallot's tetralogy. The management was conservative, consisting of evacuation of chyle and adequate protein replacement along with a low fat diet. The alternative, operative management in the form of a low ligation of the thoracic duct, should be considered if the conservative management fails after 2 weeks of trial.

Child↗
PubMedDate not supplied

[Pulmonary lymphangiectasis with spontaneous chylothorax in Noonan syndrome].

We report a case of Noonan syndrome associated with pulmonary stenosis and major lymphedema of the lower extremities. At the age of 15 yr spontaneous chylothorax with increasing dyspnea occurred> Chest-x-ray demonstrated increased interstitial markings restricted to the right lower lobe representing pulmonary lymphangiectasia. The chylothorax did not respond to repeated thoracocentesis and medium-chain-triglyceride diet. When a chest tube was inserted and total parenteral nutrition was supplied, the chylous effusion decreased within 32 days. The patient is still on diet and asymptomatic effusion remained during 12 months follow up. In conclusion, pulmonary lympgangiectasia should be considered in patients with Noonan syndrome and an abnormal interstitial pulmonary pattern similar to pulmonary congestion (without any hemodynamic abnormalities). In case of pleural effusion, chylothorax should be considered.

Adolescent↗
PubMed2003

Acute chylothorax in children: selective retention of memory T cells and natural killer cells.

OBJECTIVE: To assess for immunodeficiency in patients with hypogammaglobulinemia in the setting of draining acute chylothorax. STUDY DESIGN: Humoral and cellular immunity was evaluated in 8 patients with chylothorax. Chylous fluid was also analyzed to document cellular losses. Data regarding clinical course and immunologic characteristics were reviewed retrospectively. RESULTS: All patients had hypogammaglobulinemia (IgG=179+/-35 mg/dL) as well as lymphopenia (985+/-636 cells/mm(3)). T cells were decreased and natural killer cells increased in peripheral blood. The converse was found in chylous fluid. The ratio of CD3+/CD45RA+ naive: CD3+/CD45RO+ memory T cells was greater in chyle than in peripheral blood. In vitro proliferative responses to antigens and mitogens were similar to control subjects, and previously immunized patients maintained evidence of protective vaccine-specific humoral immunity. To treat hypogammaglobulinemia, patients received intravenous immunoglobulin (IVIG) to maintain IgG within normal range; 6 of 8 patients had serious infections before receiving IVIG compared with 4 of 8 patients during the period of IVIG administration. CONCLUSION: Draining chylothorax resulted in IgG and lymphocyte depletion with preferential retention of memory T cells and natural killer cells in the circulation. Overall, protective-specific antibody levels and T cell function were maintained. IVIG administration did not lead to discernible protection from infectious complications in this small group of patients.

Acute Disease↗
PubMed2001

Bilateral chylothorax caused by pleuropulmonary lymphangiomyomatosis: a challenging problem in thoracic surgery.

Massive left-sided pleural effusion in a 35-year-old man was initially diagnosed as idiopathic spontaneous chylothorax and treated with serial thoracenteses and left thoracotomy. Six weeks later, a right thoracotomy was performed for contralateral chylothorax, and histologic examination revealed lymphangiomyomatosis. The patient survived this rare and potentially fatal disease. We have found no previously published case of bilateral lymphangiomyomatosis treated with separate thoracotomies because of bilateral chylothorax.

Adult↗
PubMed1995

Chylothorax and chylous ascites due to malignant lymphoma.

Chyle is a fluid rich in triglycerides and is characterized by the presence of chylomicrons. Chylous effusions are unusual complications of malignant neoplasms, usually lymphomas. The combination of chyloperitoneum and chylothorax is very rare. When abdominal lymphatics are obstructed, chylous ascites results and eventually leads to a chylothorax. We present the case of a 68-year-old woman with a chyloperitoneum and a right-sided chylothorax due to an underlying malignant B-cell lymphoma. After thoracocentesis and replacement therapy with medium chain triglycerides, she was treated with a combination of cyclophosphamide, vincristine and prednisone. This has resulted in a regression of the chylous effusions. A short review of the literature describes causes, diagnosis and therapy of chylous effusions.

Aged↗
PubMed2001

Thoracoscopic management of chylothorax complicating esophagectomy.

BACKGROUND: Chylothorax is a relatively uncommon complication of esophageal surgery that may lead to severe respiratory, nutritional, and immunologic deficiencies. PATIENTS AND METHODS: Between 1992 and 2000, 3 of 316 patients (0.9%) undergoing transthoracic esophagectomy for carcinoma developed postoperative chylothorax. Two of them had previously been treated with neoadjuvant chemoradiation, and one had been submitted to esophagogastric resection through a left thoracotomy. After a 2-week trial of total parenteral nutrition and drainage, two patients underwent thoracic duct ligation via thoracotomy. In the last patient, the operation was completed by thoracoscopy. The azygos vein and the periaortic tissue above the diaphragm were encircled en bloc by a right-angled clamp, and a roticulating endostapler was applied. RESULTS: Reoperation was successful in all patients. The postoperative hospital stay was 4 days. CONCLUSION: Thoracoscopy is a safe and effective procedure for the treatment of chylothorax complicating esophagectomy. Given the minimal trauma to the patient, early thoracoscopic reoperation can be advocated in patients with high-output chyle loss in order to reduce the hospital stay.

Adenocarcinoma↗
PubMed2002

Laparoscopic ligation of the thoracic duct in management of chylothorax.

Laparoscopic ligation of the cisterna chyli at the level of the aortic hiatus was performed in a 69-year-old woman with post-lobectomy chylothorax refractory to 3 weeks of conservative therapy and one repeat thoracotomy with attempted ligation of a leaking lymphatic channel. This laparoscopic procedure was successful, and resolution of the chylothorax was achieved. We feel that this technique offers surgeons a valid, minimally invasive treatment option for a persistent chylothorax in which conservative management or more direct thoracic procedures have failed to control the chyle leak.

Aged↗
PubMed1999

Management of chylothorax after thoracoscopic splanchnicectomy.

Thoracoscopic splanchnicectomy is a minimally invasive procedure used in the treatment of recalcitrant abdominal pain in patients with chronic pancreatitis or pancreatic carcinoma. Chylothorax, an uncommon complication of thoracoscopic splanchnicectomy, may lead to a protracted, costly hospital course of treatment usually consisting of central venous hyperalimentation, restricted oral intake, and tube thoracostomy. In our series of 25 patients who underwent thoracoscopic splanchnicectomy, 2 developed postoperative chylothorax. Both patients failed conservative management and ultimately underwent operative reintervention, at which time, leaking lymphatics were easily identified and closed using minimally invasive techniques. On the basis of this experience, we advocate early thoracoscopic reintervention in patients with chylothorax after thoracoscopic splanchnicectomy.

Abdominal Pain↗
PubMed1984

Chylothorax--a complication of chest tube placement in a neonate.

A premature infant with respiratory distress syndrome developed a left chylothorax after evacuation of a left tension pneumothorax. The Argyle catheter noted in the posterosuperior mediastinum possibly traumatized the thoracic duct. Although the infant's chylothorax resolved with conservative management, he subsequently died of severe bronchopulmonary dysplasia. The potential complication of chylothorax from thoracostomy tubes can be prevented by avoiding penetration into the posterosuperior mediastinum.

Chylothorax↗
PubMed1988

Management of chylothorax after blunt chest trauma.

Chylothorax following blunt chest trauma is rare; we found only 19 cases reported. We describe an unusual patient with chylothorax from closed chest injury. The diagnosis is made from thoracentesis or tube thoracostomy fluid. Thoracostomy in the definitive therapeutic modality. Nonoperative or, when necessary, operative treatment of chylothorax after blunt trauma can lead to a successful outcome in 90% of cases.

Chylothorax↗
PubMed1997

Chylothorax as a manifestation of child abuse.

OBJECTIVE: Chylothorax presenting in a child without a well defined etiology may be a manifestation of child abuse. We recently observed a child with bilateral chylothoraces who demonstrated coexisting nonaccidental injuries. It is our intention to alert physicians to the association of chylothorax with nonaccidental trauma and review the prior medical literature. DESIGN: Case report. SETTING: Pediatric emergency department and intensive care unit. PATIENT: An 18-month-old female child who presented with respiratory distress and failure to thrive. INTERVENTIONS: Diagnostic and therapeutic thoracentesis. Skeletal survey and radionuclide bone scan. Nutritional support. OUTCOME MEASURES: Pleural fluid is characterized as chylous if it contains significant numbers of lymphocytes and lipid. Unexplained fractures of the ribs and long bones in varying stages of healing are considered nonaccidental. Failure to thrive may be considered nonorganic when nutritional support alone results in significant weight gain. RESULTS: Our patient presented with respiratory distress of one-week duration and failure to gain weight during the prior five months. The chest radiograph demonstrated bilateral pleural effusions, which were aspirated. The aspirate contained 1733 cells/mm3 (98% lymphocytes), which were lipid laden. The triglyceride concentration was 806 mg/dl. A skeletal survey demonstrated bilateral first rib, clavicle, and ulnar fractures. A radionuclide bone scan additionally revealed multiple vertebral body fractures. Nutritional support alone resulted in significant weight gain. The patient was reported to local authorities as having been abused. CONCLUSION: Child abuse should be considered as an etiology for cryptogenic chylothorax. Further studies should be undertaken in this circumstance to search for coexisting injuries, which may indicate nonaccidental trauma.

Child Abuse↗
PubMed2000

Nontraumatic chylothorax.

Nontraumatic chylothorax is an uncommon condition of thoracic or abdominal origin caused by multiple disorders, of which malignancy is by far the most frequent one. Because gross appearance of pleural fluid is frequently misleading, pleural fluid and serum lipid analysis is required for its diagnosis. In addition to the presence of chylomicrons, chylothoraces are usually characterized by all three of the following: (1) a triglyceride level of more than 110 mg/dL; (2) a ratio of pleural fluid to the serum triglyceride level of more than 1.0; and (3) a ratio of the pleural fluid to serum cholesterol level of less than 1.0. In patients with lymphoma-related chylothorax refractory to chemotherapy and radiation therapy, medical thoracoscopic talc pleurodesis has an acceptable complication rate and a 100% success rate in the prevention of recurrences. Pleuroperitoneal shunting is considered a safe and effective treatment in the management of persistent chylothorax in children in the absence of chylous ascites.

Chylothorax↗
PubMed2004

Management of chylothorax via percutaneous embolization.

PURPOSE OF REVIEW: The purpose of this review is to present a novel radiologic percutaneous transabdominal technique for treating high-output chylothorax by thoracic duct embolization, and to demonstrate that it can be potentially safer than the traditional treatment by surgical open-chest thoracic duct ligation. RECENT FINDINGS: Pedal lymphography is initially performed to opacify large retroperitoneal lymph channels; a suitable duct more than 2 mm in diameter is then punctured transabdominally to allow catheterization and embolization of the thoracic duct under fluoroscopic guidance. If feeding lymphatic channels are too small for catheterization, they can often be occluded by needle disruption. This percutaneous interventional technique, which has been used in 60 patients with mostly high-output chylothorax caused by thoracic surgery, resulted in a 65% cure rate with no morbidity. Back-up surgical thoracic duct ligation was performed promptly on suitable lower risk patients when the percutaneous procedure failed. SUMMARY: We have found that two thirds of patients presenting with life-threatening chylothorax can be safely treated by percutaneous transabdominal thoracic duct blockage. When successful, this novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays.

Chyle↗
PubMed2004

Transjugular intrahepatic portosystemic shunt creation as treatment for refractory chylous ascites and chylothorax in a patient with cirrhosis.

The etiology of chylothorax is usually considered to consist of four major categories: tumors, trauma, idiopathic conditions, and miscellaneous conditions. It appears that chylothorax is a rare and underreported manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. This condition can be debilitating as a result of respiratory compromise from a large volume of pleural fluid, as well as metabolic derangements, malnutrition, and immunologic impairment from loss of vital lymphatic constituents. Herein the authors present a case of a 46-year-old male patient with cirrhosis and complications of high-volume chylous ascites and chylothorax who was successfully treated with creation of a transjugular intrahepatic portosystemic shunt.

Chest Tubes↗