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PubMed1989

Nontraumatic chylothorax: a review of diagnosis and treatment.

The incidence of nontraumatic chylothorax is sufficiently low that most primary care physicians are unclear about the criteria for this diagnosis and the proper treatment options. A ten-year review of patients with pleural effusion treated by the university medical service identified 12 individuals with chylothorax. These patients and a current review of the English language medical literature provide us an opportunity to review the clinical presentation of chylothorax. The differential diagnosis and treatment options are reviewed.

Adult↗

PubMed1989

[The treatment of traumatic chylothorax].

Traumatic chylothorax is classified as follows; postoperative and nonsurgical. We have encountered 5 cases of traumatic chylothorax, 2 after resection of lung cancer, 2 after repair of congenital heart disease and 1 after blunt chest injury. The incidence of this complication was 0.2% after surgery for cardiovascular diseases, and 0.6% for lung cancer in our institute. We carried out operation two cases successfully, one after resection for lung cancer and the other for Tetralogy of Fallot. The treatment should be determined according to the condition of the underlying diseases. We choose conservative therapy at first which is generally recommended. When chylous discharge continues, conservative therapy should be carried out when new operative skin incision is necessary for the treatment of chylothorax. Operative therapy is desirable in cases with pulmonary resection which makes dead space in pleural cavity.

Adult↗

PubMed1988

Current management of traumatic chylothorax.

The development of a traumatic chylothorax is an uncommon but serious clinical entity. Two cases of traumatic chylothorax are reported. The anatomy and physiology of the thoracic duct and the etiology, diagnosis and management of traumatic chylothorax are discussed.

Adult↗

PubMed1985

Chylothorax after gastric resection.

Traumatic chylothorax has been described as an uncommon complication of various thoracic and cervical surgical procedures. No previous reports have been made of chylothorax following gastric resection for malignancy. Two cases of chylothorax following damage to the thoracic duct during gastric resection for malignancy are presented and the literature is reviewed. The condition was successfully managed by conservative means. Pleural aspiration, combined with total parenteral nutrition in one case and positive end-expiratory pressure ventilation in the other, resulted in complete resolution of the chylous effusions.

Adenocarcinoma↗

PubMed1984

Chylothorax as a complication of Waldenström's disease.

We describe a case of chylothorax associated with Waldenström's disease, interpreted as a rare complication of this disease. The chylothorax is probably caused by lympho-reticular infiltration of the thoracic duct. In non-traumatic chylothorax, occurring in an adult, Waldenström's disease should be considered as a possible primary cause.

Aged↗

PubMedDate not supplied

Bilateral chylothorax associated with sclerosing mediastinitis.

A 14-year-old female developed a sequential bilateral chylothorax from a complication of idiopathic mediastinal fibrosis. To the best of our knowledge, there has not been a published report of idiopathic mediastinal fibrosis followed by chylothorax. The recurrent bilateral chylothorax was treated successfully with a closed thoracostomy.

Adolescent↗

PubMed1980

[Traumatic bilateral chylothorax (author's transl)].

A case is presented of a bilateral chylothorax caused by rupture of the thoracic duct, secondary to a closed traumatism of the thorax in a polytraumatized patient, and produced by a mechanism of hyperextension of the dorsal segment of the vertebral column. Considerations are made with reference to the anatomy of the thoracic duct, the rupture mechanism, diagnosis, complications and treatment. The chylothorax could not be distinguished clinically and by simple radiology from the traumatic hemothorax. The preliminary diagnosis will be made according to the macroscopic appearance of the drained fluid, and the definite diagnosis by the analytical and histopathologic characteristics of the same fluid. The lymphographic examination reveals the exact point of the lesion. The immediate complications are related to the respiratory insufficiency due to the occupation of the pleural space, and under a long period of time undernutrition provoked by the loss of fats and proteins. The treatment of choice is based upon the early drainage of the chylothorax and on the absolute suppression of the oral intake, establishing a complete parenteral feeding during at least 15 days. Afterwards oral diet can be initiated with a gradual increase in its quantity and always without fat content, while at the same time the parenteral nutrition is reduced. Following this protocol a great number of ruptures of the thoracic duct can be corrected, achieving a spontaneous closure of the duct. In the cases in which this not occur, at the end of 15 days it would be advisable to perform a surgical operation according to the Lampson's ligature technique.

Accidents, Traffic↗

PubMed1982

Bilateral chylothorax complicating Mustard repair of transposition of the great vessels.

Less than 60 cases of bilateral chylothorax have been previously reported, and only two of these involve complicated Mustard procedures. We describe herein a patient in whom severe bilateral chylothorax developed three weeks after Mustard repair of D transposition. Complete reversal of this condition was obtained with revision of the constricted interatrial baffle and ligation of the thoracic duct. This cases is compared clinically with previously reported instances of chylothorax, and the role of played by obstruction of the superior vena cava after a Mustard procedure for transposition of the great vessels is emphasized.

Chylothorax↗

PubMed1981

[Chylothorax associated with sarcoidosis].

Chylothorax with bilateral hilar and mediastinal lymphomas has been observed in a 27-year-old patient. Further clinical investigations revealed sarcoidosis with involvement of the mediastinal lymphnodes, the bronchial mucosa and the pleural mesothelium. It is suggested that the chylothorax is a complication of sarcoidosis, although pleural effusions of chylus have thus far been reported only in traumatic or malignant diseases of the mediastinum. The pathogenesis was unclear until exploration of the pleural space by thoracoscopy showed an intact and unaffected thoracic duct. During longterm treatment with corticosteroids, supported by several pleural drainages, the chylothorax and other concomitant symptoms gradually regressed.

Adrenal Cortex Hormones↗

PubMed1995

Progressive lymphangiectasis and recurrent chylothorax in a dog after thoracic duct ligation.

A 2-year-old Bernese Mountain Dog was examined to determine the cause of bilateral pleural effusion. Torsion was diagnosed, and a lobectomy of a lung lobe was performed. Chylothorax developed 12 days after lung lobectomy. Mesenteric lymphangiography revealed lymphangiectasis Lymphangiography immediately after surgical thoracic duct was completely obstructed, but chylothorax persisted after thoracic duct ligation. Lymphangiography was repeated 50 days after ligation of the thoracic duct and revealed multiple patent thoracic duct branches and progressive lymphangiectasis. A second attempt to ligate the thoracic duct caused the effusion to become serosanguineous. A pleuroperitoneal shunt with a manually operated pump chamber was used to remove the pleural effusion. Chylothorax was again detected 50 weeks after placement of shunt. Mesenteric lymphangiography revealed multiple patent thoracic duct branches and a lymphatic plexus that extended across the thoracic cavity.

Animals↗

PubMed1993

[A case of postoperative chylothorax successfully treated by chemical pleurodesis with OK-432].

Recently, cases of postoperative chylothorax have increased concomitantly with the increase in number of aggressive thoracic surgery. Chylothorax was complicated on the 6 th postoperative day in a 69-year-old male who underwent right lower lobectomy with mediastinal lymph node dissection for adenocarcinoma of the lung. After the leaking point from thoracic duct was confirmed by lymphangiography and chest CT, OK-432 1.5 KE was instilled into the intrapleural space through a intrathoracic tube. By this procedure, the chylous fistulas were completely cured. Application of OK-432, even in such a small dose as 1.5 KE, appeared very useful for the treatment of postoperative chylothorax.

Adenocarcinoma↗

PubMed1993

Bilateral traumatic chylothorax: a complication of fracture-dislocation of the T-spine.

Traumatic chylothorax is a rare complication of fracture-dislocation of the thoracic spine. Not treated adequately, it will be associated with high mortality and morbidity. A review of the English literature shows that bilateral traumatic chylothorax is rarely discussed. A case is presented of fracture-dislocation of the third thoracic vertebra combined with bilateral traumatic chylothorax following a motor vehicle accident. The mechanism of injury is described. The management strategies are, initially, conservative treatment including chest tube drainage, NPO with total parenteral nutrition (TPN), followed by medium-chain triglyceride diet. Without improvement, surgical measures such as mediastinal ligation of the thoracic duct should be considered.

Chylothorax↗

PubMed1977

[The spontaneous, non-traumatic chylothorax. Therapy by means of pleurectomy and decortication].

Two cases of chronic spontaneus chylothorax were successfully treated by small thoracotomy with parietal pleurectomy or decortication after unsuccessful needle aspiration and intercostal tube drainage with suction. In the one case the chylous effusion occurred spontaneously 29 years after extrapleural pneumothorax. The tuberculosis was long cured. In the other, apparently idiopathic case, the chylothorax on the left side disappeared completely after pleurectomy. Six months later a chylous effusion appeared on the right side. Mediastinoscopy then revealed an oatcell carcinoma in lymph nodes without a primary pulmonary tumor. One year after radiotherapy the patient died in heart failure. No primary tumor was found. Residual chylothorax was present only on the right side.

Aged↗

PubMed1995

[Early reoperation in chylothorax after thoracic surgery].

Chylothorax is a rare complication of thoracic surgery. The chyle leak can induce serious metabolic and immunological disorders. The ideal treatment of chylothorax has not been clearly established, and opinions are still divided between medical treatment and early or late surgical reoperation after prolonged medical treatment. Out of a total of 1.750 thoracic operations performed at the Centre Chirurgical du Val d'Or over the last 10 years, six cases of chylothorax were reoperated early, an average of five days after the initial operation. The chyle leak was easy to localize in every case. The second operation was performed via the same initial incision. All six patients has an uneventful postoperative course and only one case had a persistent chyle leak which gradually resolved. The mean total hospital stay was 18 days. No systemic infections or deaths were recorded. Early reoperation avoids the complications of prolonged medical treatment, is technically easy and decreases the length of hospital stay.

Adult↗

PubMed1995

Recurrent chylothorax associated with sarcoidosis.

Spontaneous chylothorax, an uncommon manifestation of pulmonary disease, has been described in association with infectious and inflammatory conditions involving the chest, thoracic trauma, and thoracic neoplasms. Isolated chylothorax is a rare manifestation of sarcoidosis and is usually associated with the presence of mediastinal and hilar adenopathy causing obstruction of the thoracic duct. We report a case of recurrent spontaneous chylothorax in a patient with parenchymal sarcoidosis without hilar or mediastinal adenopathy.

Adult↗

PubMed1997

Chylothorax complicating a thoracic aortic aneurysm.

Chylothorax is an uncommon condition, usually associated with advanced malignant disease or trauma to the thoracic duct. Idiopathic chylothorax and other diverse causes have been anecdotally reported. We describe a rare case of chylothorax, developing as a result of damage to the thoracic duct by a thoracic aortic aneurysm. Tetracycline pleurodesis was successful in controlling the chylous effusion.

Aged↗

PubMed1997

Chylothorax after blunt chest trauma: a report of 2 cases.

Chylothorax is a rare complication of blunt chest trauma and is associated with fracture-dislocation of the thoracic spine in only 20% of these cases. Two cases of chylothorax after blunt chest injury are described in this paper; 1 was related to a fracture of the third thoracic vertebra. Closed chest drainage and total parenteral nutrition led to resolution of the condition within 3 weeks in both cases. In general, traumatic chylothorax should be managed conservatively for at least 4 weeks before surgical intervention is considered.

Accidents, Traffic↗

PubMed1997

Successful surgical treatment of bilateral congenital chylothorax: a case report.

A male infant was diagnosed at 19 days old to have a right chylothorax. Conservative management, including median-chain triglyceride (MCT) diet, total parenteral nutrition (TPN) and chyle drainage, were unsuccessful. The boy received a right thoracotomy with ligation of the thoracic duct and sutures of leaking lymphatic ducts at the age of 65 days. The result of the operation was satisfactory but left chylothorax developed six days later. Left thoracotomy was performed eight days later to suture the leaking lymphatic chains and finally the patient recovered well. Followed for one year, the patient's physical development was satisfactory. Prompt surgical intervention for congenital chylothorax is strongly recommended, if medical treatment fails.

Chylothorax↗