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PubMed2004

[Octreotide for conservative management of postoperative chylothorax].

Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.

Aged↗
PubMed2005

Surgical treatment of chylothorax caused by cardiothoracic surgery in children.

Four pediatric cases of chylothorax after cardiothoracic surgery, which were managed surgically, are reviewed retrospectively. All patients underwent right thoracotomy and mass ligation of the right thoracic duct without detecting the true site of leakage. Although 1 patient died from heart failure the day after operation, the other 3 recovered quickly without sequelae. Based on our limited experience, we suggest that right thoracotomy with mass ligation of the right thoracic duct can successfully cure chylothorax on either side, particularly if identification of the site of leakage is considered too risky because of severe adhesion from previous cardiothoracic surgery.

Cardiac Surgical Procedures↗
PubMed1988

Bilateral chylothorax following left radical neck dissection (case report).

Bilateral chylothorax is a rare complication of radical neck dissection and was first described in 1907. Stuart (1907) reviewed a number of patients with injuries to the thoracic duct in the neck and reported on three patients with bilateral chylothorax, all of whom died. The condition was not reported again until 1951 when the first of the five single case reports published to date appeared. The rarity with which this complication is reported makes it difficult for clinicians to be familiar with it. A further case is reported and the relevant literature reviewed, and certain aspects of the aetiology and management are discussed.

Chylothorax↗
PubMed2006

Bilateral chylothorax following left-sided radical neck dissection.

Chylothorax is an extremely rare but potentially life-threatening complication of radical neck dissection. Its rarity makes surgeons unfamiliar with its management. We report the case of a bilateral chylothorax occurring after a left radical neck dissection and discuss its management. A multi-disciplinary approach is advocated, involving surgical, respiratory and dietetic input, and this led to a favourable outcome for our patient.

Adult↗
PubMed2004

Successful treatment with octreotide of spontaneous chylothorax in a premature infant.

A 2-month-old premature infant developed a spontaneous chylothorax. Medical therapy (chest tube drainage, parenteral alimentation) and thoracic duct ligation at 103 days of age had no effect. Drainage ceased during an octreotide infusion. The effusion recurred after octreotide was stopped, and responded completely to a longer course of therapy. Octreotide offers a substantial advantage over current medical management to some babies with spontaneous chylothorax.

Chylothorax↗
PubMed2003

Bilateral chylothorax following radical neck dissection.

Bilateral chylothorax as a complication of radical neck dissection is extremely rare, but it is potentially serious and sometimes fatal. We found only 14 cases reported in the English literature. Here, we report a case of bilateral chylothorax following right modified and left radical neck dissections that was successfully treated with conservative management.

Aged↗
PubMed1996

Bilateral fetal chylothorax: results of unilateral in utero therapy.

The optimal method for antenatal treatment of pleural effusions from congenital chylothorax unknown. A fetus with bilateral congenital chylothorax and hydrops had a pleural catheter placed in utero on only one side of the fetal chest for 14 days prior to delivery. The fetal hydrops partially resolved. After birth there was significantly less drainage from the pleural space that had been antenatally drained. This case demonstrates potential neonatal advantages of pleuro-amniotic shunt placement.

Adult↗
PubMed1988

[Problems of idiopathic chylothorax].

Conservative management of a chylothorax in a 57-year-old man was unsuccessful (25 l chylous fluid removed over three weeks). But chylous flow ceased immediately after thoracotomy with ligation and resection of the thoracic duct. The aetiology of the chylothorax remained obscure despite extensive preoperative diagnostic measures and histological examination of the thoracic duct.

Chylothorax↗
PubMed1996

Successful treatment of chylothorax by bleomycin for Gorham's disease.

A patient with idiopathic osteolysis in the thoracolumbar spine who developed severe chylothorax after a spinal operation is described. Irradiation and pleural adhesion therapies with minocycline and bleomycin were undertaken to control the chylothorax. Pleural adhesion therapy with bleomycin proved effective in treating this patient. Magnetic resonance imaging was performed to detect the lesion. T1 weighted imaging was particularly useful in diagnosing the lesion and evaluating the degree of fusion in the spine.

Adult↗
PubMed1999

Management of postoperative chylothorax with nitric oxide: a case report.

OBJECTIVE: To describe the use of inhaled nitric oxide in the management of refractory postoperative chylothorax. DESIGN: Case report. SETTING: A pediatric intensive care unit of a tertiary care children's hospital. PATIENT: A neonate with refractory chylothoraces complicated by moderate pulmonary hypertension after a complicated arterial switch operation. INTERVENTIONS: Administration of inhaled nitric oxide through a ventilator circuit. MEASUREMENTS AND MAIN RESULTS: The institution of inhaled nitric oxide at 20 ppm resulted in a marked reduction in chest tube drainage and a decrease in echocardiographically estimated pulmonary artery pressure from 50%-75% systemic to 30%-50% systemic. Chest tube drainage doubled when the nitric oxide was decreased to 10 ppm and, again, dramatically decreased after raising nitric oxide back to 20 ppm. After 8 days of nitric oxide therapy, the chest tube drainage ceased. Nitric oxide therapy was successfully discontinued 19 days after initiation, with no recurrence of chylothorax. There was no effect of nitric oxide on systemic blood pressure. Methemoglobin levels while on NO remained <1.7%. CONCLUSION: Consideration may be given to the use of inhaled nitric oxide in the therapy of refractory chylothoraces complicated by central venous hypertension.

Administration, Inhalation↗
PubMed1988

Chylothorax following traumatic amputation of upper arm.

A young patient who had traumatic amputation of left arm developed extensive chylothorax on right side of chest. The pathophysiology appears to be left subclavian thrombosis secondary to gross sepsis of the amputation stump which resulted in occlusion of thoracic duct opening and chylothorax. The child was successfully treated by closed chest tube drainage.

Amputation, Traumatic↗
PubMed1996

Massive chylothorax complicating cirrhosis of the liver.

Chylothorax is an unusual complication of cirrhosis of the liver. This condition is probably underdiagnosed because appropriate tests are not usually done. We describe the case of a 54-year-old man with cirrhosis of the liver and massive chylothorax. Despite chest tube drainage and intensive supportive therapy, there was a fatal outcome. Our case highlights the difficulties in the management of this complication and draws attention to the possible dangers of certain therapeutic procedures.

Chest Tubes↗
PubMed1994

Chronic lymphocytic leukaemia complicated by chylothorax.

Chylothorax is a very rare complication of chronic lymphocytic leukaemia: we describe an 81-year-old woman with chronic lymphocytic leukaemia complicated by chylothorax. Treatment with mediastinal irradiation and chemotherapy was unsuccessful. The pleural effusion resolved after talc pleurodesis.

Aged↗
PubMed1996

Congenital chylothorax in a patient with 21 trisomy syndrome.

A female infant with 21 trisomy syndrome associated with congenital chylothorax was reported. She was born at a gestational age of 34 weeks by Cesarean section because of fetal hydrothorax and hydrops fetus, confirmed by ultrasonography at 32 weeks. Emergent resuscitation and immediate thoracentesis were performed soon after birth. After beginning breast feeding, the serous pleural fluid became opalescent and a diagnosis of congenital chylothorax was made. Feeding was changed to medium-chain triglyceride (MCT) feeding and the production of pleural effusion disappeared after thoracentesis was performed several times. Accumulating evidence suggested that MCT feeding and intermittent thoracentesis under echo guide were effective. Some reports on patients, including this one, suggest that there may be more patients with 21 trisomy associated with congenital hydrothorax. Therefore, congenital hydrothorax might be listed as a complication of 21 trisomy.

Chylothorax↗