Expectoration of bronchial casts in association with Ramipril treatment

[Surgery for chyloptysis]

Chyloptysis is a rare disease characterized by formation of bronchial casts containing chyle and repeating bronchial tree branching. The authors report a 56-year-old woman with chyloptysis accompanied by cough and expectoration of milky bronchial casts, as well several episodes of asphyxia. Stages of diagnosis and successful treatment including thoracic duct ligation and skeletonization of the root of the left lung are described. The authors also analyze literature data on etiology, pathogenesis and feasibility of conservative and surgical treatment of these patients.

On the nature of peculiar expectorated bronchial casts: Can infrared spectroscopy enlighten us?

BACKGROUND

Bronchial casts can be defined as gelatinous structures originating from the airways. While several cases of bronchial cast formation have been reported in literature, unravelling its nature is often a difficult task.

METHODS

In this case report, we applied infrared (IR) spectroscopy on a bronchial cast fragment originating from a patient who suffered from a 2-y history of frequent coughing accompanied by the occasional expectoration of viscous and thick white-yellow bronchial-like structures.

RESULTS

Based on a markedly high lipid to protein ratio and presence of long-chain fatty acids, the resulting IR spectrum appeared to be very suggestive for chyloptysis.

CONCLUSION

Taking into account the patient's prior history of radiation therapy for a lymphoma complicated by congestive heart failure, we hypothesized that an impairment of adequate lymphatic flow into the venous system due to a combination of lymphatic obstruction and high venous pressures is the most plausible culprit.