[Chylothorax in an 87-year-old patient]

An 87-year-old woman presented with a left-sided pleural effusion. The milky aspirate fulfilled the criteria of a chylothorax. Thorax computed tomography (CT) showed characteristic multiple cysts and consequently the rare diagnosis of post-menopausal pulmonary lymphangioleiomyomatosis was made. In the diagnostic work-up of pleural effusion the determination of triglycerides should be considered to confirm the diagnosis of chylothorax. In the presence of a chylothorax the differential diagnosis of lymphangioleiomyomatosis should be included even in advanced age.

Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisited. A multicenter retrospective study

This retrospective study was carried out at eight Neonatal Intensive Care Units (NICU) Centers worldwide on 33 newborns presenting at birth with pleural, pericardial, or abdominal chylous effusions. Diagnosis of chylous effusion is based on findings of fluid with a milk-like appearance, a concentration of triglycerides in pleural effusion >1.1 mmol/l, and a total cell count >1,000 cells/ml with a predominance of >80% lymphocytes. Thirty-three newborns met the inclusion criteria and were studied. Six subjects who presented at birth with fetal effusion were treated by in-utero pleuro-amniotic shunt. Five of these patients are alive at follow-up. At birth, pleural drainage was performed in 29/33 patients and abdominal drainage was carried out in 3/33. Total parenteral nutrition (TPN) was given to 32/33 patients; 19/23 patients were fed a medium-chain triglycerides (MCT). No adverse effects were observed. Eight patients were treated with Octreotide at dosages ranging from 1 to 7 mcg/kg/hour for 8 to 35 days. All patients showed decreased chylous production. Two patients were treated by pleurodesis. Twenty-two babies are alive after at least 6 months follow-up, 9/33 are deceased, and 2 were lost to follow-up. Clinical conditions of survivors are basically good except for lung involvement [chronic lung disease (CLD) or lung lymphangiectasia] and lymphedema. All patients were using a MCT diet at follow-up with good control of chylous effusion. Visceral chylous effusions of the fetus and neonate are rare disorders, and there currently is only partial agreement on decision-making strategies. We suggest the need for an international prospective trial in an effort to establish the efficacy and effectiveness of diagnostic and therapeutic options described in this article.

Idiopathic chylothorax: pathophysiology, diagnosis, and thoracic duct imaging

Idiopathic chylothorax is a debilitating disease that can lead to respiratory and metabolic compromise and fibrosing pleuritis. Previous investigation has provided theories for the etiology of this poorly understood disease. This article provides an overview of the pathophysiology and diagnosis of chylothorax. Thoracic duct imaging, including minimally invasive techniques, is also discussed, as it is frequently performed in the perioperative period. A companion article reviews nonsurgical and surgical techniques for treating and managing idiopathic chylothorax in dogs and cats.

Chyloperitoneum, chylothorax and lower extremity lymphedema in woman with sporadic lymphangioleiomyomatosis successfully treated with sirolimus: a case report

Lymphangioleiomyomatosis (LAM) is a rare disease characterized by diffuse thin-walled cysts throughout the lungs on computed tomography and diffuse proliferation of abnormal smooth muscle-like cells (LAM cells) on lung biopsy. LAM affects women almost exclusively, predominantly in their reproductive age. The most typical presenting symptoms include dyspnea, spontaneous pneumothorax, cough and chylothorax. Abdominal findings represent less common initial manifestations of the disease and may pose diagnostic difficulties. The treatment of LAM has not been fully established. Recent studies report effectiveness of sirolimus in LAM patients. We report the case of a 45-year-old woman with sporadic LAM, successfully treated with sirolimus, in whom the first manifestation of the disease was chyloperitoneum and after three and nine years, respectively, lymphedema of the left lower extremity and right sided chylothorax occurred.

[Measuring pH in pleural fluid is valuable when identifying the cause of purulent pleural effusion]

A 79 year-old woman with disseminated ovarian cancer and recurring pleural effusions, had thoracocentesis performed with drainage of purulent pleural fluid (plf) after preceding symptoms of pneumonia. Pleural empyema was suspected. However, a plf-pH-measurement of 7.3 made this diagnose less likely. A subsequent analysis of plf revealed an elevated plf-triglyceride concentration, thus confirming chylothorax. In order to distinguish between pleural empyema and chylothorax plf-pH should be considered as a routine analysis in patients with underlying malignancy and drainage of purulent pleural fluid.

[Simvastatin indused chylothorax]

Chylothorax is a rare disorder occurring most often in aftermath of a thoracic surgery or during cancer of mediastinum. We report the clinical history of the world's second case of chylothorax which appeared during treatment with simvastatin.

Ergotamine-associated valvulopathy with recurrent chylous pleural effusion

We report a rare case of ergotamine-associated mitral stenosis in a 55-year-old woman who presented with recurrent chylous pleural effusion. Echocardiographic, gross, and microscopic features of the mitral valve were consistent with chronic ergotamine-induced valvulopathy. We conclude that medication-induced valvulopathy should be included in the differential diagnosis of valvular heart disease. In addition, cardiac function should be monitored before and during long-term therapy with ergotamine or ergotamine-derived dopamine agonists.

[A case of spontaneous chylothorax complicating pregnancy]

The paper gives a clinical case of left-sided chylothorax developing in a young woman in the second half of pregnancy due to thrombosis of the left internal jugular vein, left subclavian vein, and brachiocephalic trunk. Cesarean section was made. Medical treatment thereafter proved to be effective. The possible mechanisms for spontaneous venous thrombosis and chylothorax during pregnancy and the methods of their diagnosis and treatment are discussed.

[A case of chylothorax in which thoracoscopy under local anesthesia and thoracic duct scintigraphy were useful to locate the leakage site]

BACKGROUND

Detailed investigation of the cause of chylothorax and its treatment should be performed by thoracoscopy under general anesthesia, but if this is difficult due to multiple complications it is possible to perform a detailed investigation by combining thoracoscopy under local anesthesia and thoracic duct scintigraphy.

CASE PRESENTATION

A 74-year-old woman presented with exertional dyspnea. Chest X-ray films showed right pleural effusion, and thoracocentesis yielded a milky white pleural effusion, meeting the criteria of chylothorax, after excluding conditions such as malignant lymphoma, amyloidosis and trauma. Since the patient's medical history included pacemaker insertion, dialysis and diabetes, thoracoscopy was performed under local anesthesia rather than general anesthesia, to investigate the cause in detail. The pleural cavity was visualized, but no obvious tumor or other cause was present in the parietal pleura. There was partial adhesion of the lower lobe and chest wall, and the leakage of a milky white pleural effusion from this site was confirmed. We then performed thoracic duct scintigraphy, which revealed an area of enhancement corresponding to the leakage site near the right pulmonary hilum.

CONCLUSION

We describe a case in which thoracoscopy under local anesthesia and thoracic duct scintigraphy were useful for determining the leakage site in chylothorax.

Idiopathic chylothorax and lymphedema in 2 whippet littermates

Idiopathic chylothorax and limb edema was diagnosed in two 2-year-old male whippet siblings. The fact that the 2 related animals developed similar clinical signs at a young age may suggest a congenital or hereditary etiology.

Constrictive pericarditis presenting as chylothorax

Chylothorax is a rare clinical condition that can be attributed to a damaged thoracic duct. The condition is suggested by aspiration of milky white fluid from the pleural cavity and is commonly associated with either malignant diseases or trauma (e.g. cardiothoracic surgery). We present the case of a 15-year-old boy with chylothorax, whose effusion was due to constrictive pericarditis. The definitive treatment of chylothorax involves identification and management of the underlying pathology. We suggest that when dealing with cases of chylothorax, constrictive pericarditis should be considered among the causes.

Surgical management of chylopericardium and chylothorax in a patient with Behçet's disease

Behçet's syndrome is a chronic multisystem inflammatory disease characterised classically by recurrent oral and genital ulcers with ocular lesions. It can affect blood vessels of all sizes, but involves veins more commonly than arterie. The presence of chylothorax in Behçet's syndrome is rare, with only a few cases cited in the literature. The most likely pathogenesis is SVC thrombosis with obstruction of the orifice of the thoracic duct resulting in leakage of chyle from the pleural lymphatics into the pleural space. The majority of the previously reported cases were managed medically without surgical intervention. We believe that this report describes the first use of surgery to ligate the thoracic duct and create a pericardial window in a Behçet's syndrome with chylothorax and chylopericardium.

[Influence of prolonged treatment with octreotide on GH, IGF I, insulin, ACTH, cortisol, T3, T4 and TSH secretion in a case of congenital chylothorax]

Congenital chylothorax is a rare condition characterized by the accumulation of lymph fluid in the pleural space that causes respiratory and circulatory dysfunctions, immune deficiencies, hypoalbuminemia, electrolyte imbalance and alterations of the coagulation. Mortality rates are elevated and can rise to 50%. Therapy consists in conservative treatment based on thoracic drainage combined with total parenteral nutrition or use of low-fat high-protein diet supplemented with medium chain triglycerides. In case of failure surgical intervention may be considered. During the last years some authors have experienced the use of octreotide with doubtful results. In no case the drug impact on insulin, GH and cortisol secretion in neonatal age has been investigated and only in one case the effect on thyroid hormones has been assessed. We report the case of a 36-week baby with congenital chylothorax treated with octreotide for 42 days. The drug was well tolerated but hormonal level measurements showed a deep depression of insulin secretion unaccompanied by alterations of glucose levels. Levels of GH and TSH showed only a transitory decrease. ACTH and cortisol remained normal. At 5 months, the measurements of hormonal levels did not show significant alterations. It is not possible to determine if such a drug played an essential role in the solution of the pleural effusion, but it is important to emphasize that a prolonged treatment with octreotide has not caused, in our case, persistent hormonal alterations.

[Chylothorax]

Chylothorax is the accumulation of chyle in the pleural space. In newborns the congenital form is often prenatal diagnosed, while the late variety originates to damage to the thoracic duct by cardiac surgery, diaphragmatic hernia, etc. Clinical presentation results from the accumulation of pleural fluid and the symptoms depends on the size of the effusion. The treatment needs both medical and surgical care. The pleural cavity should be drained via thoracocentesis, and total parenteral nutrition should be started. Afterward fat-free diet with the addition of medium-chain triglycerides could be initiate. Somatostatin and octreotide have been successfully employed, mainly in post-surgery chylothorax. Surgery should be considered when medical management fails. Some approaches are reported, and thoracic duct ligation, pleurodesis and pleuroperitoneal shunts are the most utilized. The prognosis of chylothorax depends on the etiology, and it is consequence of a variety of treatments that may influence the outcome.

Transudative chylothorax associated with sclerosing mesenteritis

Transudative chylothorax is an uncommon type of chylous pleural effusion, typically secondary to chyle leak and a coexisting disorder such as heart failure or liver cirrhosis. Sclerosing mesenteritis is a rare inflammatory disease of the small bowel mesentery, and has once previously been reported as a cause of chylothorax. We present the case of an 81-year-old man with a right-side transudative chylothorax associated with congestive heart failure and sclerosing mesenteritis. We discuss potential mechanisms.

Chylous ascites and chylothorax: an unusual manifestation of cardiac amyloidosis

Restrictive cardiomyopathy is an extremely rare cause of massive chylous ascites and chylothorax. We report a 56-year-old man patient who presented with chylous ascites and bilateral chylothorax; 12-lead electrocardiography and echocardiography revealed restrictive cardiomyopathy. Endomyocardial biopsy disclosed amyloidosis.

[Diagnosis and treatment of chylothorax]

In chylothorax, chyle has accumulated into the pleural clarity. Chylothorax is a fairly rare finding, most commonly arising after procedures within the thoracic cavity. Suspicion of chylothorax is based on anamnesis and clinical picture, with chest radiograph and pleural fluid puncture as the basic tests. Treatment should be started immediately after a confirmed diagnosis. In the early stages it is vital that the production of chyle is minimized and the fluid is drained. If the conservative treatment fails, surgery is recommended

A systematic approach to the investigation and diagnosis of a unilateral pleural effusion

Fluid in the pleural space is a common sequela of a wide range of diseases which may be pulmonary, pleural or extrapulmonary. As the differential diagnosis is wide, a systematic approach to investigation and diagnosis is recommended. This review highlights the important features and recommendations for the investigation of a unilateral pleural effusion, a common condition encountered by the general physician. The aim of this study was to assist with a speedy diagnosis of the underlying pathology, using appropriate investigative techniques, while minimising the use of invasive procedures.

[Paragonimiasis Westermani associated with pseudochylothorax]

A 67-year-old woman was referred to our hospital because of right pleural effusion. She had eaten boiled crab, Eriocheir japonicus, raw crab of an unknown species, and broiled wild boar several years ago. The punctured pleural fluid was characterized by an exudative nature, milky-white color, and high cholesterol concentration, indicating pseudochylothorax. High titers of anti-Paragonimus westermani antibody in the pleural fluid and serum, assessed by microplate ELISA, established the diagnosis of Paragonimiasis Westermani. Treatment with praziquantel at 75 mg/kg for 3 days, for 2 repeated courses, ameliorated the pleural effusion and decreased the antibody titers. An exhaustive search of the literature failed to find a similar case of pseudochylothorax associated with P. westermani.

Paragonimiasis presenting with unilateral pseudochylothorax: Case report and literature review

A 64-y-old female previously treated for lung fluke presented with shortness of breath and moderate left pleural effusion. Thoracentesis was performed and milky pleural effusion was obtained. Paragonimus ova and rhomboidal cholesterol crystals were found. Paragonimiasis was diagnosed, and the patient was treated with praziquantel 25 mg/kg/d.

[Chylothorax - case report]

Chylothorax is the occurrence of lymph in the pleura due to damage or obstruction of the thoracic duct. High content of triglycerides and the presence of chylomicrons make the diagnosis of chylothorax. Its aetiology can be divided in traumatic and non-traumatic. Traumatic rupture occurs after accidents or surgery. Within non-traumatic aetiology, lymphoma is the most common and in the presence of a chylothorax of unknown origin this should be the first suspicion, being non-Hodgkin type the most frequent. The authors present a case report of a patient with chylothorax due to non-Hodgkin lymphoma, discuss the particularities of chylothorax as well as the investigation and its treatment options.

A contemporary review of chylothorax

OBJECTIVES

This review will focus on anatomical and aetiologic factors as well as the conservative and operative therapy of chylothorax.

DATA SOURCE

A Pubmed search for studies pertaining to the aetiology and/or treatment published in the English language from 1960 to 2007.

STUDY SELECTION

Studies presenting case reports, series, observational and/or retrospective studies, and those with unique issues pertaining to chylothorax were reviewed independantly by both authors. Studies that were selected by both authors contain most clinically relevant data.

RESULTS

Chylothorax is caused by injury or obstruction of the thoracic duct or its main tributaries leading to chyle accumulation in the pleural space. It most commonly occurs from trauma or malignancy, but other causes have been described. Although chylous effusions are rare, they have serious clinical consequences including cachexia and immunodeficiency. There are no evidence-based guidelines to assist in the management of this disease.

CONCLUSIONS

A prompt diagnosis is needed to start treatment of the underlying cause. Treatment can be divided into conservative and surgical interventions. There are no evidence-based guidelines to assist in the management of this disease. Initial conservative therapy includes intercostal decompression of the pleural effusion along with nutritional support in the form of total parenteral nutrition, and reduction of chylous formation with somatostatin. Surgical interventions include thoracic duct ligation, pleuroperitoneal shunt and percutaneous embolisation.

Bilateral chylothorax in a child after mild trauma

Chylothorax is a life-threatening form of pleural effusion with a varied aetiology. In this report, we describe the case of a child who developed bilateral chylothorax following minor trauma which responded well to conservative management.

[Surgical treatment of persisting chylothorax]

Results of surgical treatment of 8 patients, suffering chylothorax, persisting during 1-14 months are presented. The desease have appeared also resistant to complex conservative treatment trial. This kind of treatment was conducted with simultaneous intensive preoperative preparation, surgical intervention consisted of open thoracotomy with thoracic duct suturing and ligature. The operative treatment had appeared primarily ultimately successful in 5 (62.5%) patients, and after postoperative pleurodesis conduction--in 3 (37.5%). One week of intensive conservative therapy trial with simultaneous preoperative preparation and subsequent shift to surgical intervention constitutes an optimal tactical principle in the persisting chylothorax treatment.

Graves' disease with intractable diarrhea, chylous ascites, and chylothorax: a case report

A 50-year-old woman was admitted to our hospital because of severe diarrhea, irritableness, and severe pitting edema of the legs. The patient had been well until 5 years before admission, when a tremor and tachycardia developed and a diagnosis of Graves' disease was made. Treatment with methimazole was effective in reducing her tremor and tachycardia; however, she was often nonadherent with her antithyroid medication because of improvement of her symptoms. On admission, a thyroid swelling, exophthalmos, a pleural effusion, and ascites were observed. The results of thyroid function tests (free triiodothyronine: 21.5 pg/mL; free thyroxine: 7.17 ng/dL; thyroid-stimulating hormone (TSH): <0.01 microIU/mL; TSH receptor antibodies: 95.9%) were consistent with Graves' disease. Biochemical analysis of pleural and ascitic fluid was consistent with chylothorax and chylous ascites, respectively. Serum calcium, total protein, and albumin were very low. Her symptoms and signs except severe diarrhea, edema, pleural effusion, and ascites disappeared after receiving intravenous drip infusion of fluid replacement, and methimazole and iodine. Because of malnutrition, she was given a high-calorie intravenous infusion. Three months after admission, her pleural effusion and ascites began to improve, as did her diarrhea and hypoalbuminemia. An appropriate treatment of Graves' disease is crucial to avoid serious sequelae of longstanding, poorly controlled hyperthyroidism.

[Case of idiopathic chylothorax successfully treated with surgical ligation of thoracic ducts]

A 72-year-old woman visited a clinic for anorexia and general fatigue but no particular abnormality was detected by routine examination at that time. Thereafter, she experienced gradually increasing dyspnea and chest X ray showed right pleural effusion. Idiopathic chylothorax was diagnosed due to the milky effusion with a high concentration of triglyceride (2618 mg/dl) and no apparent causative disease. Irrespective of treatments including dietary restriction, drainage of the pleural space, and somatostatin injections, her effusion did not reduce. The leakage of lymph fluid from the right posterior mediastinum was identified by lymphatic scintigraphy and she was successfully treated with surgical ligation of the thoracic ducts.

Pleural effusions in the neonate

PURPOSE OF REVIEW

This review highlights the pathophysiological mechanisms, incidence, clinical features, as well as the diagnosis and treatment of pleural effusions in the neonate.

RECENT FINDINGS

Pleural effusions are rare except in hydropic neonates. Elevated pleural fluid/serum immunoglobulin G ratio may be a diagnostic marker for congenital chylothorax in utero. Chylothorax may be congenital or acquired. Hydrothoraces may appear at any time during the neonatal period and are related to infectious and noninfectious aetiologies. Haemothorax is defined as the presence of blood in the pleural space. Parenteral nutrition leakage may occur in a newborn with a venous central catheter leading to an effusion that looks like a chylothorax. The value of elevated pleural fluid N-terminal pro-brain natriuretic peptide levels as a marker of congestive heart failure is not yet established in neonates. More recently, in cases of chylothorax that did not resolve with drainage and bowel rest, the use of somatostatin or its analogue octreotide has been described with success. If conservative management fails after 5 weeks, surgical intervention is indicated.

SUMMARY

Clinicians must be aware of the wide range of disorders causing pleural effusions, the different types and clinical presentations, differential diagnosis, and how to treat each specific case.

A case of Gorham's disease complicated by bilateral chylothorax

Gorham's disease is a very rare disorder of uncertain aetiology, characterised by non-neoplastic proliferation of vascular or lymphatic channels within bone leading to resorption and replacement of osseous matrix with angiomatous tissue. Fewer than 200 cases have been reported in the literature. The complication of chylothorax is associated with a high morbidity and mortality. We present the case of a 17-year-old male with Gorham's disease of the sternum, clavicle and rib, complicated by bilateral chylothorax. Despite thoracic duct ligation and radiotherapy, the patient progressively deteriorated and died 36 weeks following initial presentation.

[Fetal chylothorax. Is prenatal treatment beneficial?]

We report a case of fetal chylothorax handled with intrauterine treatment, which finally died. Diagnosis, treatment and evolution are reviewed. Characteristics of the disease are described and treatment options are discussed.

[Chylothorax]

Chylothorax, an uncommon cause of pleural effusion, is usually secondary to malignancy, trauma, congenital diseases, infections and superior vena cava thrombosis. The early diagnosis and treatment are important to prevent the most fearful consequence of chylothorax, the malnutrition with a compromised immunological status.

Bilateral chylothoraces without chyle leakage after left-sided neck dissection for thyroid cancer: report of two cases

Bilateral chylothorax is a rare complication of neck dissection, but it is potentially serious and sometimes life threatening. Because of the rarity of chylothorax, surgeons are unfamiliar with its early signs, which allow a prompt diagnosis and effective management. Most cases reported in the literature were associated with a concurrent external chyle leakage, which occurred either during or after surgery. We report two cases of bilateral chylothoraces without concurrent external chyle leakage, which occurred after left-sided neck dissections for thyroid cancer. We treated both patients successfully with conservative management.

Thoracoamniotic Shunting with Double-Basket Catheters for Fetal Chylothorax in the Second Trimester

The progress of a fetal severe pleural effusion at mid-trimester is extremely poor. We encountered a fetus that developed a severe left pleural effusion at 21 weeks of gestation. The pleural effusion was removed by thoracocentesis at 22 weeks. Cytology revealed abundant lymphocytes, suggesting chylothorax. However, a reaccumulation of pleural effusion with hydrops was subsequently noted, and a thoracoamniotic shunt with double-basket catheters was installed at 23 weeks. The pleural effusion decreased after 24 weeks and completely disappeared at 26 weeks. At 40 weeks of gestation, a female infant was born by vaginal delivery, with no evidence of pleural effusion. We would like to stress that thoracoamniotic shunt with double-basket catheters in the second trimester is effective for pleural effusion with hydrops.

[Chylothorax in the fetus and the neonate--guidelines for treatment]

Chylothorax is the most common pleural effusion in the fetus and the neonate. Actual treatment of chylothorax includes many different antenatal and postnatal therapeutical approaches. The authors present practical and summarized guide- lines for the treatment of chylothorax in the fetus and the neonate, including the new therapies somatostatin and octreotide.

Minimally invasive management of chylous fistula after esophagectomy

Chyle leak is an unwelcome complication of esophagectomy that is associated with a high mortality. The diagnosis of this condition may be difficult or delayed and requires a high index of suspicion. Management varies from conservative treatment with drainage, intravenous nutrition, treatment and prevention of septic complications, to re-operation, either by thoracotomy or laparotomy to control the fistula. To reduce the mortality, early surgical intervention is advised and a minimally invasive approach has recently been reported in several cases. From June 2002 through August 2005 we have used video-assisted thoracoscopic surgery to diagnose and treat chyle fistulas from 6/129 (5%) patients who underwent esophagectomy for resectable carcinoma of the esophagus or high-grade dysplasia. The fistula was successfully controlled in 5/6 cases by direct thoracoscopic application of a suture, clips or fibrin glue. One patient required a laparotomy and ligation of the cysterna chyli after thoracoscopy failed to identify an intrathoracic source of the leak. An early minimally invasive approach can be safely and effectively applied to the diagnosis and management of post-esophagectomy chylous fistula in the majority of cases. Open surgery may be appropriate where minimally invasive approaches fail or where the availability of such skills is limited.

Tension chylothorax in two pediatric patients

Although the accumulation of gas is the most common cause of an expanding interpleural space, the presence of other structures or substances (hydrothorax, gastrothorax, hemothorax, urohemothorax, pyothorax, and chylothorax) under pressure may be sufficient to cause hemodynamic and respiratory compromise. We present two pediatric patients that developed hemodynamic and respiratory effects secondary to a chylothorax. The first patient presented in respiratory distress and cardiovascular collapse 4 weeks after a Fontan procedure. Placement of a chest tube resulted in the release of chyle under pressure and prompt resolution of hemodynamic and respiratory symptoms. The second patient was a 2100 g neonate who developed a chylothorax during an episode of sepsis following gastroschisis repair. On two separate occasions, the development of the chylothorax was associated with tachycardia, oliguria, and increased requirements during mechanical ventilation. Chest tube placement resulted in the release of chyle under pressure and resolution of the symptoms. These two cases demonstrate that chylothorax like pneumothorax can have deleterious effects on hemodynamic and respiratory function.

Three cases of bilateral chylothorax developing after neck dissection

Only 16 cases of bilateral chylothorax following neck dissection have been reported within 10 decades. In this paper, three cases of bilateral chylothorax which developed after neck dissection are reported. In all cases, conservative treatment resulted in resolution of the condition. Diagnosis may be delayed in those who are on total parenteral nutrition, and therefore particular attention should be paid to those patients. It may be difficult to treat cases of chylothorax that develop following neck dissection performed after radiotherapy.

Spontaneous chylothorax associated with light physical activity

Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct, resulting in the release of chyle into the pleural space. Chylothorax can occur in cases of congenital lymphatic malformation, lymphoma, mediastinal tumor and infectious disease, as well as during surgical procedures and after traffic accident-related trauma. It can also be idiopathic. The condition presents clinical signs of dyspnea, hypotension, generalized edema and cyanosis. The diagnosis is usually made through thoracocentesis, and the treatment is conservative. Spontaneous chylothorax is an uncommon form of pleural effusion, and its diagnosis should be hypothesized only after all other causes have been ruled out. Herein, we describe a case of spontaneous chylothorax associated with light physical activity at a fitness center.

Pleural fluid/serum immunoglobulin ratio is a diagnostic marker for congenital chylothorax in utero

OBJECTIVE

To distinguish congenital chylothorax from other causes of hydrothorax in utero.

METHODS

Serum and pleural fluid samples from 8 fetuses with congenital chylothorax and 5 control fetuses with other causes of hydrothorax were tested for total protein, albumin, IgG, IgA, and IgM.

RESULTS

Fetuses with congenital chylothorax had higher levels of IgG in pleural fluid, but not the other four proteins, than control fetuses (P<0.05). There were no significant differences in serum proteins among fetuses. When we examined pleural fluid to serum ratios, the IgG ratio in fetuses with congenital chylothorax was significantly higher than that of control fetuses (P<0.05). The IgG ratio in chylothorax was greater than 0.6 regardless of lymphocyte count.

CONCLUSION

Pleural fluid/serum IgG ratio may be a diagnostic marker for congenital chylothorax in utero.

Life threatening chylothorax in a patient with congenital thrombophilia: case report

We reported here a case of bilateral chylothorax as a result of widespread thrombi formation in a patient who was heterozygote for factor V leiden gene mutation and who had antithrombin III deficiency. We performed bilateral chest tubes, thrombolytic and oral anticoagulant therapy. The patient responded to the therapy. She has been in follow up without symptoms for 18 months.