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PubMed2005

Octreotide for treating chylothorax after cardiac surgery.

Chylothorax is a rare but serious complication of cardiac surgery, with a poor prognosis unless treated properly. We report the case of 66-year-old woman who developed chylothorax after coronary artery bypass grafting. The chylothorax was successfully treated in 8 days by means of subcutaneous octreotide administration and a diet that contained medium-chain triglycerides. Octreotide, a long-acting somatostatin analog, is an effective and safe agent for the treatment of postoperative chylothorax and may reduce the need for reoperation.

Aged↗
PubMed2006

[Effects of octreotide acetate on intractable chylothorax after surgery for congenital heart diseases].

We experienced 2 infants in whom octreotide acetate was effective on intractable chylothorax after surgery for congenital heart diseases. They were 8- and 5-month-old. They were diagnosed as having corrected transposition of the great arteries (TGA) and tetralogy of Fallot respectively, and underwent bidirectional Glenn anastomosis and right modified Blalock Taussig shunt. Chylothorax was revealed on the 11th and the 1st postoperative day, and was not improved by any conventional therapy in either case. Then octreotide acetate was infused continuously with 0.1-0.6 micorg/kg/hour for 24 and 7 days. Chylothorax disappeared completely without any complications such as disturbance of blood sugar level or growth retardation. Octreotide acetate was effective and safe even in infants in intractable chylothorax after surgery for congenital heart diseases, as long as used for short period.

Cardiac Surgical Procedures↗
PubMed2006

[A case of idiopathic chylothorax detected by the mass examination of chest X-ray].

A 52-year-old asymptomatic man was referred to our hospital due to right pleural effusion detected on a chest X-ray mass screening. Chest X-ray film and chest CT showed moderate pleural effusion. The effusion was milky yellow, suggesting a high triglyceride level. There was no organic disease that would cause chylothorax so his condition was diagnosed as idiopathic chylothorax. The patient's right pleural effusion increased although he had been receiving outpatient dietary therapy for one month. He was consequently admitted to our hospital and received drainage of the pleural space and pleurodesis by intrapleural injection of OK-432. His condition was greatly improved by the therapy and he was discharged. There are few reports of idiopathic chylothorax in adults. Such a case of idiopathic chylothorax detected by chest X-ray mass screening has never been reported before. We, therefore, conclude that this case is very rare and has unique aspects.

Chylothorax↗
PubMed1991

Hyponatremia and hyperkalemia associated with idiopathic or experimentally induced chylothorax in four dogs.

Two dogs with idiopathic chylothorax and 2 dogs with experimentally induced (ie, ligation of the cranial vena cava) chylothorax were treated by intermittent thoracic drainage. Of these 4 dogs, 3 that did not have evidence of renal failure had normal or near-normal serum sodium and potassium concentrations before thoracic drainage began, and all 3 developed repeatedly marked hyponatremia and hyperkalemia during thoracic drainage. Another dog became weak and depressed, ostensibly because of hyperkalemia. Serum sodium and potassium concentrations in 1 dog with spontaneous chylothorax returned to normal after chylothorax resolved and thoracic drainage was stopped. The other 3 dogs died or were euthanatized, and the effect of stopping thoracic drainage could not be evaluated. In 3 dogs in which it was measured, normal-to-high plasma cortisol concentration was observed before and after adrenocorticotropin administration, and 2 dogs also had hyperaldosteronemia. Hyponatremia was hypothesized to be caused by sodium loss via thoracic drainage whereas hyperkalemia may have been multifactorial in origin, but probably was attributable, at least, in part to decreased renal potassium clearance.

Animals↗
PubMed1988

Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy.

Chylothorax is an unusual complication after transhiatal esophagectomy (THE) and in the past 10 years has occurred in 11 of 320 patients (3%) undergoing this operation for diseases of the intrathoracic esophagus. Four patients had benign esophageal disease: scleroderma reflux esophagitis (1), caustic stricture (1), and achalasia (2), and each had undergone at least one previous esophageal operation. Seven patients had intrathoracic esophageal carcinoma--two upper-third, two middle-third, and three distal-third lesions. Excessive chest tube drainage more than 72 hours after THE was the standard presentation, and the diagnosis of chylothorax was confirmed by the administration of cream through the jejunostomy feeding tube placed routinely at operation. The character of the chest tube drainage changed from serous to opalescent. Aggressive treatment of this complication was the rule, and every patient underwent a thoracotomy between 2 to 14 days (average, 6 days) after the diagnosis was established. Cream was administered through the jejunostomy tube before operation, and in each case the thoracic duct injury was readily identified and controlled with suture ligatures. There were no deaths in this group, and there was one recurrence of the fistula that required reoperation; all patients were discharged from the hospital within 3 to 29 days (average, 10 days) after thoracic duct ligation. It is concluded that early recognition of a chylothorax after transhiatal esophagectomy with prompt transthoracic ligation of the injured duct results in a shorter overall hospitalization and lower morbidity and mortality from this complication. The traditional conservative management of chylothorax with intravenous hyperalimentation and no or low-residue enteral feedings has little place in this nutritionally depleted patient population.

Adult↗
PubMed1987

[Chylothorax: treatment using talc pleurodesis].

Chylothorax is a rare complication of lymphoma with a poor prognosis. The treatment is not well established. We report a case of lymphoma complicated by bilateral chylothorax in which, despite optimal chemotherapy and radiotherapy, pleural effusion persisted. Pleuroscopy was performed under local anesthesia, followed by pleural instillation of pure talc. The immediate result was satisfactory and six months later there was no recurrence of chylothorax. Talc pleurodesis appears to be a simple and safe way of treating chylothorax resistant to conventional therapy.

Chylothorax↗
PubMed1985

Chylothorax associated with blastomycosis in a dog.

Respiratory distress caused by pleural effusion resulted from chylothorax. Thoracic drainage and lowfat dietary therapy was effective in removing and preventing significant recurrence of the chylothorax; however, the patient died unexpectedly. At necropsy a blastomycotic granuloma found at the precava was considered the cause of the chylothorax. There had been no recognizable antemortem signs of blastomycosis. Blastomycosis can be considered as a rare cause of chylothorax.

Animals↗
PubMed1984

Bilateral spontaneous chylothorax presenting as a neck mass.

Chylothorax is a relatively rare condition. Bilateral chylothorax is even more unusual with the majority resulting from trauma or in association with a neoplasm. We describe a case of bilateral spontaneous chylothorax which presented as a sudden neck mass in a 45 year old, healthy female. A complete evaluation failed to reveal any cause. Successful management included thoracentesis and a medium chain triglyceride diet. The patient remains well with a normal chest x-ray and CAT scan of the thorax and abdomen at one year. Spontaneous bilateral chylothorax presenting as a neck mass with no evidence of trauma or tumor has, to our knowledge, not previously been reported in the literature.

Chylothorax↗
PubMed1982

[Chylothorax and the pathology of the lymphatic pleura].

The diagnosis of chylous effusions of the pleura hardly poses any problems if one carefully differentiates the true chylothorax rich in triglycerides from chylous effusions rich in cholesterol and poor in triglycerides. The pathology of chylothorax requires a double breach of both thoracic duct and pleura. The causes are dominated by complications of thoracic surgery direct trauma, closed chest injuries and malignant mediastinal tumours. Other rarer causes raise the difficult problem of the spontaneous chylothorax. Even the idea of an idiopathic chylothorax is controversial and makes one suspect the rupture of a previously fragile thoracic duct, following apparently minimal trauma. Treatment is not yet standardised but requires strict rest, and a medium chain triglyceride diet, correction of fluid and electrolyte balance and careful nutrition. Surgery, generally delayed for a few weeks, may lead to the repair of a lymphatic leak, localised by a biological tracer or a contrast material; sometimes only a ligature at the base of the thoracic duct will dry up the effusion. The prognosis still remains mediocre and is dominated by the cause, notably when this is a tumour and also by the localised or diffuse character of the lymphatic disturbance.

Adult↗
PubMed1995

Chylothorax in the dog and cat: a review.

Chylothorax is a rare but complex disorder in domestic animals. Etiologies include neoplasia, fungal infections, heartworm infestation, cardiac disease, thrombosis of the cranial vena cava, and congenital anomaly of the thoracic duct. Most cases of chylothorax in dogs and cats are idiopathic. Positive contrast lymphangiography on dogs and cats with chylothorax consistently reveals extensive lymphangiectasia of mediastinal and pleural lymphatics. Reported treatment modalities for chylothorax in animals include removal of the etiologic agent, such as a mediastinal tumor, thoracic duct ligation, and implantation of active or passive drainage devices such as a pleuroperitoneal shunt. Thoracic duct ligation has been most successful in our experience, but continued study is needed since treatment failures are common.

Animals↗
PubMed1995

Chylothorax associated with constrictive pericarditis in a dog.

Chylothorax was associated with constrictive pericarditis in a 6-year-old mixed-breed dog. Clinical signs included hepatomegaly, bilateral jugular pulses, muffled heart sounds, and dyspnea. Pleural effusion was identified on thoracic radiographs. Thoracentesis yielded 3 L of chylous effusion, confirmed by the cholesterol/triglyceride ratio (0.14). Echocardiography revealed a thickened pericardium, with numerous fibrin tags, which was suggestive of constrictive pericarditis. Central venous, right atrial, and right ventricular pressures were high and on right ventricular diastolic pressure tracings, the square-root sign, which is indicative of constrictive pericarditis, was evident. Exploratory thoracotomy and pericardiectomy were performed. Histopathologic findings were consistent with chronic non-suppurative pericarditis. The dog's condition improved after surgery. On reevaluation 11 months later, central venous pressure and results of physical examination and thoracic radiography were normal. On the basis of these findings, we concluded that chylothorax was caused by constrictive pericarditis in this dog. Chylothorax is often associated with disorders that have a poor prognosis, but if constrictive pericarditis can be identified as the cause of the chylothorax, exploratory thoracotomy and pericardiectomy can provide a cure.

Animals↗
PubMed1994

[A case of idiopathic chylothorax--successful pleurodesis with OK-432].

A 73-year-old woman was referred to our hospital because of left pleural effusion. Chyle was obtained by thoracocentesis. Because there was no organic lesion to cause chylothorax, idiopathic chylothorax was diagnosed. Her condition improved by chest-tube drainage and pleurodesis with intrapleural injection of OK-432. We report a rare case of idiopathic chylothorax and conclude that pleurodesis with intrapleural injection of OK432 is very useful for the treatment of idiopathic chylothorax.

Aged↗
PubMed1993

[A case of idiopathic chylothorax].

A 29-year-old female was admitted to our hospital because of right pleural effusion. Chyle was obtained by thoracocentesis. She received conservative therapy, however, the pleural effusion did not decrease. Thoracic duct ligation was performed, and improvement of the chylothorax was observed. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. Idiopathic chylothorax is a rare disease and only 24 cases have been reported in Japan.

Adolescent↗
PubMed1996

[The changes in lymphocytes subpopulations of a patient with postoperative chylothorax].

A case of 64-year-old male who developed chylorrhea at 2 days post coronary artery by-pass grafting, is reported. He was managed conservatively for 3 weeks. But chylothorax was not improved, he was treated operatively. Analysis of his lymphocyte subpopulations in peripheral blood were performed during the course of chylothorax. Lymphocytepenia became apparent and subpopulation of T cell were decreased gradually. The subpopulation of CD 4(+) cell decreased, while the subpopulation of CD 8(+) increased. The CD 4(+) cell/CD 8(+) cell ratio decreased consequently till 7th day after 2nd operation. Although the replenishment of nutritional deficiencies using TPN allows prolonged conservative management for chylothorax patient, the deterioration in cellular immunocompetence can not be prevented at present. It is necessary to take great care about infection for chylothorax patient.

CD4-CD8 Ratio↗
PubMed1997

[Clipping of the thoracic duct with video-assisted thoracic surgery in the treatment of chylothorax after pulmonary resection].

We describe a procedure for video-assisted thoracoscopic clipping of the thoracic duct to treat postoperative chylothorax. This technique was successfully performed on a 62-year-old man who developed chylothorax following right lower lobectomy and partial resection of the 11th and 12th vertebral bodies for squamous cell lung cancer. Because conservative therapy for 7 days failed to reduce the amount of pleural effusion, we performed thoracoscopic examination of the thoracic duct and found a site leaking chylous fluid. The thoracic duct was successfully and easily clipped resulting in complete elimination of the effusion in 2 days. Generally, chylothorax complicating pulmonary resection has been managed by medical treatment first, followed by surgical intervention in case that fail to respond to initial therapy. The newly designed video-assisted thoracic surgery procedure reduces the trauma, shortens the drainage period and hospital stay, and provides better exposure of the thoracic duct. We believe that this procedure can be carried out shortly after the occurrence of chylothorax.

Chylothorax↗
PubMed1997

Management of chylothorax.

BACKGROUND: Chylothorax is a rare primary or secondary condition the optimum management of which remains uncertain. METHODS: Twenty cases of chylothorax, including ten of primary chylothorax and ten secondary to either malignancy, subclavian vein thrombosis or lymphangioma treated between 1956 and 1986 have been reviewed. RESULTS: Open pleurectomy was the most successful treatment in preventing reaccumulation of the effusion. Three patients had thoracic duct-azygous vein anastomoses, but all anastomoses were probably occluded within a year of surgery. Three patients have been lost to follow-up and five died within 2 years of their treatment, but 12 patients were alive and free from an effusion 3-22 years after treatment. CONCLUSION: Patients with chylothorax should undergo lymphangiography to identify the cause and site of the lymphatic abnormality. Conservative treatment is successful in some patients but should be abandoned if the fluid loss exceeds 1.5 l/day for more than 5-7 days in an adult or more than 100 ml/day in a child. Parietal pleurectomy is the most successful treatment when no distinct chylous leak can be identified. Less commonly, an isolated chylous leak either in the chest or in the abdomen may be identified and this should be treated by direct ligation.

Adult↗
PubMed1998

Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax.

UNLABELLED: Lymphoscintigraphy allows functional assessment of lymphatic transport and depiction of regional lymph nodes, is fast and nontraumatic and has no known side effects. We retrospectively analyzed lymphoscintigraphic studies to determine their efficacy in the investigation of chyluria, chyloperitoneum and chylothorax. METHODS: Twenty-one whole-body lymphoscintigrams using 99mTc-antimony sulfide colloid or dextran were acquired in 18 patients with chyluria, chyloperitoneum and/or chylothorax. The images were reviewed to assess the rate of tracer transport and number, size and distribution of lymph vessels and nodes as well as the presence of collateral, fistula or lymph reflux. RESULTS: Lymphoscintigraphy was normal (5 of 11 patients) or showed lymphatic obstruction (6 of 11 patients) in chyluria associated with filariasis. Lymphatic obstruction was demonstrated in chyloperitoneum and/or chylothorax associated with liver cirrhosis (2 patients), postoperative (1 patient) or congenital (1 patient) lymphatic dysplasia, inferior vena cava obstruction (1 patient) and nephrotic syndrome (1 patient). Enhanced lymph flow was seen in systemic lupus erythematosus (1 patient). Follow-up lymphoscintigrams showed patency of lymphovenous anastomosis (1 patient), improvement (1 patient) or no change (1 patient) in lymphatic drainage after treatment. CONCLUSION: Lymphoscintigraphy can demonstrate abnormal lymphatic drainage in chyluria, chyloperitoneum and chylothorax. It is useful for selecting patients for surgery and assessing the effect of treatment.

Adult↗
PubMed1998

[Chylothorax resulting from malignant non Hodgkin's lymphoma].

We report a case of chylothorax with malignant non-Hodgkin's lymphoma. A 51-year-old man was admitted to our hospital with a chief complaint of dyspnea on March 18, 1995. An x-ray film of the chest revealed a large right pleural effusion. Biochemical tests of the pleural fluid revealed chyle. CT scans of abdomen and chest showed retroperitoneal and mediastinal tumors. Examination of biopsy specimens of the retroperitoneal tumor showed non-Hodgkin's lymphoma (diffuse small cell type, B cell). Treatment with chemotherapy (CHOP, ProMACE-CytaBOM) resulted in complete remission. The chylothorax disappeared after chemotherapy. Only 21 cases of malignant lymphoma with chylothorax have been reported in Japan to date, but their numbers are gradually increasing. We must consider malignant lymphoma in patients with chylothorax.

Antineoplastic Combined Chemotherapy Protocols↗