Chyluria and chylothorax after posterior selective fusion for adolescent idiopathic scoliosis

Delayed Chylothorax Following Blunt Chest Trauma Treated with Repeated Lymphangiography: A Case Presentation

Chylothorax is mostly iatrogenic, with blunt chest trauma being a rare cause. Treatment depends on the volume of drainage. Specifically, conservative treatment, such as total parenteral nutrition and pleural drainage, is performed in cases of low daily output (< 500 mL/day). Patients with persistent chylothorax despite medical treatment or with high daily output (> 1-1.5 L/day) are candidates for surgical or radiological intervention. We present a case of delayed-onset chylothorax after blunt trauma caused by thoracic spine fractures, in which persistent chylothorax was successfully managed with repeated lymphangiography with lipiodol when other treatment modalities failed. The case is peculiar in that the chylothorax occurred 40 days after the initial traumatic event and was treated with lipiodol injection, despite maintaining moderate to high daily output.

Chylous Leak During Posterior Approach to Juvenile Scoliosis Surgery: A Case Report

CASE

We report the first documented case of chylous leak recognized intraoperatively during posterior spinal instrumentation and fusion for juvenile scoliosis in a female patient with a history of thoracotomy and decortication for an empyema.

CONCLUSIONS

Thoracic duct injury can lead to severe morbidity and mortality because of chylothorax formation. Although chylous leaks are a well-documented complication of the anterior approach to spine surgery, leaks during the posterior approach are rarely reported. When these chylous leaks are recognized intraoperatively, the likelihood of serious complications may be minimized by drain placement before closure.

Chylothorax after spinal fusion surgery: A case report and literature review

Chylothorax is reported as a postoperative complication, mainly in the field of thoracic surgery, but there are only 14 reports in the field of spinal surgery.

A 64-year-old woman underwent spinal fusion surgery by the anterior and posterior approach for her scoliosis. She developed leg edema and right pleural effusion 2 months after the surgery. Laboratory findings showed decreased total protein and albumin levels in serum. The color of the thoracentesis sample was pinkish white, and the Triglyceride level in the pleural effusion was high. So, her leg edema was found to be associated with malnutrition and the pleural effusion was caused by chylothorax. The point of leakage from the lymph duct was confirmed in the right thoracic cavity of the slice that corresponded to that with the screw at Th11 by lymphatic scintigraphy. Her symptoms did not improve by diet restriction and lipidol lymphography, but her pleural effusion and albumin levels improved by the administration of octreotide. In the clinical course, serum albumin levels appeared to show an inverse correlation with the amount of pleural effusion, so it was thought that her serum albumin level decreased owing to leakage of protein, including albumin, into the thoracic cavity via the injured thoracic duct.

We concluded that the chylothorax was owing to complications of the surgery. Although reports of chylothorax occurring as a complication of spinal fusion surgery are rare, when prolonged hypoalbuminemia or unilateral pleural effusion is observed, chylothorax should be considered as a differential diagnosis.

Chyluria in non-filarial endemic areas: an internist's perspective

A 60-year-old Chinese woman presented with intermittent, painless, gross haematuria and subsequently complained of persistent milky urine. The diagnosis of chyluria was confirmed after cystoscopy demonstrated ureteric milky fluid discharge which had elevated levels of triglycerides. The patient did not travel to filarial endemic areas and her serum circulating filarial antigen was negative. Intravenous pyelography with CT of the abdomen did not reveal any masses or obstruction. It was determined that her chyluria was non-parasitic in origin and her symptoms improved with a low fat, high-protein diet. However, her chyluria recurred 1 year later, resulting in hypoalbuminaemia and proteinuria. Her symptoms resolved and her albumin levels normalised with adherence to dietary modifications.