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PubMed2001

Lymphogenous cyst-vein shunt in the management of chylothorax and chylorrhea.

A 36 year-old woman developed marked lymphedema and chylous cysts of the lower abdominal wall, groin, labia, accompanied by chylorrhea. After cyst excision and transplantation of the greater omentum, a left chylothorax occurred. After thoracic duct ligation and left pleurodesis, pleural effusion recurred and worsened. Lymphangioscintigraphy and conventional lymphography suggested that undrained enlarged retroperitoneal lymphatics in the right iliac fossa had disrupted and lymph had leaked into the left chest from the right iliac fossa. Treatment by a lymphatic cyst-vein anastomosis redirected excess chylous lymph into the blood circulation and chylothorax initially remitted. Several years later with recurrence of chylorrhea, the anastomosis was found to be occluded. After a second operative connection between a lymphogenous cyst and the greater saphenous vein, chylorrhea subsided and chylothorax has remitted for more than 4 years.

Abdominal Muscles↗
PubMed2001

Bilateral chylothorax after left radical neck dissection.

Bilateral chylothorax, as a complication of neck dissection, is very rare as evidenced by the 11 cases reported in the literature up to date. We present an additional case of bilateral chylothorax following a left radical neck dissection and concomitant chylous neck fistula. This case was successfully treated by chest drainage and total parenteral nutrition. Early diagnosis of chylothorax is urged due to the consequences on metabolism and respiratory conditions. Management by aspiration drainage is usually sufficient to control pleural effusions.

Carcinoma, Squamous Cell↗
PubMed2002

[Lymphoscintigraphy for chylothorax after replacement of descending thoracic aortic aneurysm].

A 77-year-old female with Stanford B chronic aortic dissection, received elective replacement of descending aorta. The aorta distal to the aneurysm was encircled with a tape, and replaced using the double barrel technique. After the operation, chest X-ray showed effusion on the bilateral side. The amount of milky fluid from drain increased to 2,000 ml per day. The chemical profiles of the fluids were compatible with chylothorax. The Thoracic duct near the diaphragm was closed through left mini-thoracotomy. But the leakage of chyle did not cease. The lymphoscintigraphy showed a leakage to right lower intrathorax near the diaphragm and native aorta. A defect of the thoracic duct was closed, and chylothorax was cured. This case shows that though detailed anatomical structure of thoracic duct is not revealed, lymphoscintigraphy is useful for the localization of leakage in patients with chylothorax of post-cardiovascular-surgery.

Aged↗
PubMed2002

[A case of diffuse malignant mesothelioma of the pleura with bilateral chylothorax].

We describe a case of bilateral chylothorax with malignant pleural mesothelioma. A 41-year-old woman was admitted to our hospital because of dyspnea. She had no history of exposure to asbestos. A chest radiograph and chest computed tomogram (CT) on admission revealed massive bilateral pleural effusion and a large tumor with pleural thickening in the left lateral and anterior parts of the pleura and mediastinum. Biochemical tests of pleural fluid revealed chyle. Two years before, she had been diagnosed through histological and histochemical examinations as having diffuse malignant pleural mesothelioma of the epithelial type. Chest-tube drainage was performed, and pleurodesis was induced by the intrathoracic injection of OK-432 at 10 KE per dose. The chylothorax disappeared after pleurodesis. To date, reports of malignant mesothelioma with nontraumatic chylothorax have been rare.

Adult↗
PubMed2003

[Chylothorax: an unexpected complication of artificial ventilation in severe acute asthma].

INTRODUCTION: Complications of mechanical ventilation for severe acute asthma are common and are related essentially to barotrauma. However, the incidence has declined in recent years thanks to different techniques of ventilation. CASE REPORT: We report a case of spontaneous chylothorax occurring during the course of ventilation in a patient with severe acute asthma where the ventilatory parameters were in accordance with current recommendations. Recovery was straightforward with resolution of the chylothorax and no recurrence either immediately or later. Exhaustive clinical, biological and morphological investigations failed to find any cause other than the mechanical ventilation. CONCLUSION: This case of chylothorax may be considered as a rare barotraumatic complication of severe acute asthma.

Acute Disease↗
PubMed2003

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases.

In children, chylothorax occurs mainly after cardiac and thoracic surgeries. One of the recommended postsurgery treatments is ligation of the thoracic tract, when all other conservative treatments have failed. We report 4 cases of chylothorax in patients who were successfully treated with this approach, which resulted in a decrease in pleural drainage without recurrent chylothorax.

Aged↗
PubMed2004

[Lymphangioleiomyomatosis (LAM) causing chylothorax].

A 28-year-old woman was admitted to our hospital complaining of chest pain and dyspnea. Chest radiographs showed left pleural effusion. The effused fluid obtained by thoracocentesis was milky, and so chylothorax was diagnosed. A high-resolution chest CT (HRCT) scan demonstrated diffuse multiple cystic lesions, which were undetectable by conventional CT. An abdominal CT scan showed a retroperitoneal tumor. Since the effusion was resistant to conservative therapy, we performed clipping of the thoracic duct under the diaphragm. Since the effusion disappeared after continuous aspiration, 10 KE of OK-432 was administered into the pleural cavity, and the chylorrhea disappeared. The clinical diagnosis, based on the biopsy of the abdominal tumor, was lymphangioleiomyomatosis. Chylothorax developing from lymphangioleiomyomatosis is rare in Japan. However, we must consider the possibility of lymphangioleiomyomatosis in patients with chylothorax, and always perform chest HRCT.

Adult↗
PubMed1992

Severe bilateral fibrosing pleuritis associated with chronic chylothorax in five cats and two dogs.

Severe bilateral fibrosing pleuritis was diagnosed in 5 cats and 2 dogs with chronic chylothorax. All animals were dyspneic on initial examination and remained moderately to severely dyspneic after thoracentesis. Radiographic evidence of fibrosing pleuritis included rounded lung lobes and failure of the lungs to reexpand following effective pleural drainage. Fibrosing pleuritis was also suggested in several animals with radiographic evidence of pleural fluid, in which pleural fluid could not be retrieved. Macroscopically, the lung lobes of all animals were compressed and atelectatic to various degrees, and the pleura appeared to be diffusely thickened and roughened. In several animals, fibrous adhesions were found between the parietal and visceral pleura of some lobes. Lung lobes were markedly constricted and appeared as small, smooth, rounded hilar masses in 4 animals. Mild to moderate pulmonary edema was evident in 3 animals at necropsy. Six of the 7 animals died (2) or were euthanatized (4) within 72 hours after the diagnosis of fibrosing pleuritis. The fibrosing pleuritis developed in 1 animal with lymphoblastic lymphosarcoma and chylothorax after treatment via passive pleuroperitoneal drainage; this animal was euthanatized because of underlying neoplasia. One cat, in which decortication was performed and resulted in marked reexpansion of the lung lobes, died 4 hours after surgery with signs compatible with pulmonary edema. On the basis of our findings, we suggest that animals with chronic chylothorax are at risk to develop fibrosing pleuritis. Furthermore, animals with severe bilateral fibrosing pleuritis should be given extremely guarded prognoses.

Animals↗
PubMed2004

Chylous ascites and chylothorax due to constrictive pericarditis in a patient undergoing haemodialysis.

Chylous ascites and chylothorax are rare clinical entities and usually caused by neoplasms, particularly lymphomas, liver cirrhosis, superior vena cava thrombosis, nephrotic syndrome, and some cardiac events such as dilated cardiomyopathy or right heart failure. Constrictive pericarditis is an extremely rare cause of this clinical state. We report a 41-year-old male patient undergoing haemodialysis who presented with chylous ascites and chylothorax. Echocardiography and heart catheterisation revealed constrictive pericarditis. He underwent pericardiectomy and after the operation the ascites and pleural effusion resolved rapidly. We suggest that constrictive pericarditis should be considered in the differential diagnosis of chylous ascites and chylothorax.

Adult↗
PubMed2004

Conservative treatment of postoperative chylothorax with octreotide.

Chylothorax is a rare but serious and well-recognized complication of general thoracic and cardiac procedures. No new invasive or non-invasive definitive therapies are available. This article reports the case of a 67-year-old woman who underwent myocardial revascularization and who developed a postoperative chylothorax necessitating continuous drainage and conservative management. When after 1 week this treatment still had not resolved the chylothorax, octreotide was instituted, leading to a rapid cessation of chyle production and rendering surgical management of this complication unnecessary.

Aged↗
PubMedDate not supplied

Effectiveness of somatostatin in the conservative management of chylothorax.

Chylothorax is a rare but potentially serious and well recognized cause of pleural effusion. Chylothorax commonly occurs following general thoracic and cardiac procedures. Additionally it sometimes develops secondary to non-surgical trauma, i.e. weight lifting. Here we report two additional cases with chylothorax. Somatostatin was added to conservative treatment protocol to increase effectiveness of therapy in both cases. Although the first case required surgical intervention, we avoided any surgical procedure in the second patient with conservative management combined with somatostatin.

Adolescent↗
PubMedDate not supplied

[Chylothorax. An infrequent complication in surgical exeresis of the esophagus].

We report a case of massive bilateral chylothorax occurring after surgical resection of the esophagus in a patient with esophageal neoplasm. The surgical approach consisted of a thoracotomy and a cervicostomy. The relevance of this case is based on the low incidence of chylothorax after esophageal surgery. The literature indicates an incidence of about 0.9 to 3%. In our series of 200 patients operated on during the last 10 years we found and incidence of 2%. The patient herein reported presented an immediate postoperative clinical picture of respiratory insufficiency associated with the presence of milky fluid in the pleural drainage. Hematologic and biochemical examination of the pleural fluid confirmed the diagnosis of chylothorax. During the first 24 hours we collected a total volume of 2,500 ml of chyle. The patient was treated with conservative procedures including parenteral nutrition and intravenous reposition of fluids. After 48 hours the total volume of chyle reached 8,500 ml and the patient died.

Carcinoma, Squamous Cell↗
PubMed2006

[Idiopathic chylothorax: usefulness of aetiologic survey and the follow-up].

Chylothorax is an uncommon condition. It's characterized by the presence of chyle in the pleura. The most common causes are malignancy and trauma. When an underlying cause is excluded, the chylothorax is called idiopathic. We report a case of a 68 aged woman, admitted for abundant chylothorax. Thoraco-abdominal computed tomography, magnetic resonance imaging of the chest and thoracotomy showed no lesion of the lymphatic duct. Fibrothorax has developed after pleurodesis. Stable clinical and radiological condition was noticed during 3 years. We discuss the difficulty in the exclusion of a malignancy and the necessity of the follow up for these patients.

Aged↗
PubMed1991

[Therapeutic pleurodesis in spontaneous pneumothorax, malignant pleural effusion, heart insufficiency and chylothorax].

Treatment with pleurodesis is employed in spontaneous pneumothorax, in pleural effusion due to neoplastic disease, intractable transudate and chylothorax. When this treatment is employed in spontaneous pneumothorax, randomized studies show a lower recurrence rate when drainage is supplemented by a sclerosing agent. Pleurodesis alone scarcely alters the recurrence rate in pneumothorax. Treatment with pleurodesis is well accepted in malignant pleural effusion. Several randomized studies show a response rate of 11% when thoracocentesis is employed alone whereas a response rate of 40% is obtained when pleural drainage is also employed. When a sclerosing agent is added to pleural drainage, the response rate rises to approximately 60% or more. No randomized studies of pleurodesis in congestive heart failure and chylothorax were found. Pleurodesis is not recommended in the treatment of congestive heart failure because of reports of development of contralateral pleural effusion after successful pleurodesis. In chylothorax, pleurodesis is the last resort.

Chylothorax↗
PubMed1990

[Antenatal diagnosis and management of congenital chylothorax].

A case of congenital chylothorax diagnosed with prenatal ultrasonography is described. Thoracocentesis was performed at 33 weeks of gestational age but recurrence of chylothorax, increasing hydramnios and subcutaneous oedema made cesarean section necessary at 37 weeks. Mechanisms of chylothorax during the fetal life and its management before and after delivery are discussed.

Adult↗
PubMed1990

[Chylothorax after cardiothoracic surgery].

8 patients with postoperative chylothorax were reported: 7 after resection of esophageal carcinoma, 1 after radical correction of tetralogy of Fallot. 1 case was treated conservatively and 7 by ligation of thoracic duct after rethoracotomy. All the cases recovered. The factors causing postoperative chylothorax, the principles of treatment, and the role of prophylactic ligation of thoracic duct were discussed. The authors point out that, the mechanisms of postoperative chylothorax after open heart surgery by sternotomy may be: (1) injury of perithymotic and anterior mediastinal lymph ducts; (2) injury of thoracic duct through posterior wall of pericardium; and (3) effect of hypertension of systemic veins on flow of thoracic duct.

Adolescent↗
PubMed1990

Current treatment of chylothorax: a case series and literature review.

All cases of chylothorax occurring over a 15-year period in the teaching hospitals of a large Texas medical school were reviewed. This series of 12 patients indicated that chylothorax is a rare event that can be successfully approached with nonoperative therapy for several weeks provided the nutritional and metabolic status of the patients are not adversely affected. Thoracostomy with tetracycline pleurodesis was used in several patients but did not appear to be superior to thoracostomy alone. The surgical experience in this series was limited, but the occasional need for surgical intervention is reviewed. This series suggested that aggressive nonoperative therapy including nutritional manipulation can result in a low mortality when it is followed by surgical intervention if no evidence of resolution of chylothorax occurs.

Adult↗
PubMed1989

[Idiopathic chylothorax in an adult--a case report and a review of 14 cases in Japan].

A 30-year-old female with an idiopathic chylothorax who underwent successful surgical treatment was reported. The patient was referred to our hospital because of massive right pleural effusion found by chance on the X-ray. Thoracocentesis revealed chyle but the etiology was not known by examinations. Conservative treatments such as fasting, intravenous hyper-alimentation and a continuous drainage were performed for 10 weeks without remarkable improvement. A right thoracotomy revealed nothing abnormal except for the oozing of lymph from mediastinal pleura, which was sutured by 3-0 nylon. Postoperative course was uneventful and no recurrent pleural effusion has been recognized for 3 years since then. Adult chylothorax with unknown etiology like this is rare and only 13 cases have been reported in Japan. Such "idiopathic chylothorax" cases, including our case, were reviewed and discussed.

Adult↗