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Ellebrecht DB, Hoge M, von Weihe S. [Chylothorax]. Zentralbl Chir 2024; 149:133-147. [PMID: 38442889 DOI: 10.1055/a-1990-4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Chylothorax is a serious and potentially life-threatening condition of diverse etiology. This article provides a detailed overview of anatomy, physiology, etiology, diagnosis, and therapeutic options in the context of chylothorax.
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Yan Z, Xi J, Li J, Li Z, Han X, Yang Z. Postpartum chylothorax: Two case reports and literature review. Radiol Case Rep 2024; 19:424-430. [PMID: 38033667 PMCID: PMC10684367 DOI: 10.1016/j.radcr.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Postpartum chylothorax is an infrequent complication of delivery that is sometimes overlooked. We presented 2 cases of chylothorax in primiparous women who developed chest tightness and breath shortness after vaginal birth, probably due to increased pressure in the thoracic ducts during labor. Lymphography with iodine oil revealed leakage at the T4 level of the thoracic duct in 1 patient but not in the other. Only trace amounts of iodized oil were deposited in the thoracic cavity. There was a significant decrease in postoperative drainage. However, the treatment did not yield the anticipated curative effect in either case. Eight incidences of postpartum chylothorax were identified in the reviewed literature. Patients with refractory chylothorax may benefit greatly from lymphography since it can detect structural changes and determine whether there is a leaking in the thoracic duct. Lymphography-guided therapy for chylothorax with a verified leak has the potential to be both effective and safe. Lymphangiography can serve as a useful tool in selecting the optimal surgical strategy.
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Affiliation(s)
- Zhentao Yan
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Junqing Xi
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuochao Li
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiangjun Han
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhengqiang Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Norman JS, Testa S, Wang CX, Savage T. Milky Way: Management of Primary Intestinal Lymphangiectasia. Dig Dis Sci 2023; 68:3872-3877. [PMID: 37634185 DOI: 10.1007/s10620-023-08077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Joshua S Norman
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA.
- , Stanford, USA.
| | - Stefano Testa
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - Cindy Xinnan Wang
- Department of Pathology, Stanford University, Stanford, CA, 94304, USA
| | - Thomas Savage
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA
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Moguillansky N, Ataya A. Postpartum Chylothorax: A Case Report and Review of the Literature. Cureus 2023; 15:e47839. [PMID: 38021837 PMCID: PMC10676774 DOI: 10.7759/cureus.47839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Idiopathic postpartum chylothorax is an uncommon finding, with only four cases described in the literature. We present the case of a 37-year-old female who was diagnosed with chylothorax three days after the delivery of her baby. Chylothorax was managed with chest tube placement, a low-fat diet, and octreotide. As opposed to the current literature, her chylothorax resolved with medical management and chest tube insertion without further surgical intervention. The chest tube was removed 11 days after chest tube placement, and she was discharged in stable condition. We also review the most recent literature on postpartum chylothorax.
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Affiliation(s)
- Natalia Moguillansky
- Department of Medicine, Division of Pulmonary Critical Care, and Sleep Medicine, University of Florida Health, Gainesville, USA
| | - Ali Ataya
- Department of Medicine, Division of Pulmonary Critical Care, and Sleep Medicine, University of Florida Health, Gainesville, USA
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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Fornés S, Bielsa S, Porcel JM. Sneeze-induced chylothorax. Arch Bronconeumol 2021; 57:558-559. [PMID: 34053893 DOI: 10.1016/j.arbr.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sonia Fornés
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Silvia Bielsa
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - José Manuel Porcel
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
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Fornés S, Bielsa S, Porcel JM. Sneeze-Induced Chylothorax. Arch Bronconeumol 2021; 57:S0300-2896(21)00001-6. [PMID: 33494943 DOI: 10.1016/j.arbres.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sonia Fornés
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - Silvia Bielsa
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - José Manuel Porcel
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, España.
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Abstract
Isolated thoracic duct injury is an uncommon clinical event and is rare in the setting of trauma. We describe a case of an isolated thoracic duct injury resulting in the development of bilateral chylothorax following a motor vehicle collision in the absence of any other definable injury. We outline the initial patient presentation and diagnosis. After failing a trial of conservative management the patient underwent lymphangiography followed by thoracic duct ligation with pleurodesis. This case highlights the importance of recognizing thoracic duct injury following trauma.
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Affiliation(s)
- Shelby Champion
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Daniele Wiseman
- Department of Medical Imaging, London Health Science Centre, London, Ontario, Canada
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Riley LE, Ataya A. Clinical approach and review of causes of a chylothorax. Respir Med 2019; 157:7-13. [PMID: 31454675 DOI: 10.1016/j.rmed.2019.08.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022]
Abstract
A chylothorax, also known as chylous pleural effusion, is an uncommon cause of pleural effusion with a wide differential diagnosis characterized by the accumulation of bacteriostatic chyle in the pleural space. The pleural fluid will have either or both triglycerides >110 mg/dL and the presence of chylomicrons. It may be encountered following a surgical intervention, usually in the chest, or underlying disease process. Management of a chylothorax requires a multidisciplinary approach employing medical therapy and possibly surgical intervention for post-operative patients and patients who have failed medical therapy. In this review, we aim to discuss the anatomy, fluid characteristics, etiology, and approach to the diagnosis of a chylothorax.
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Affiliation(s)
- Leonard E Riley
- University of Florida College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, FL, USA
| | - Ali Ataya
- University of Florida College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, FL, USA.
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Abstract
PURPOSE OF REVIEW This review evaluates recent research findings and proposes an up-to-date diagnostic approach for patients with suspected chylothorax. RECENT FINDINGS Typically, chylothorax is a milky exudate with high triglyceride content (>110 mg/dl). However, milky appearance is not always the case and triglyceride levels can be less than 110 mg/dl, especially in fasting or malnourished patients. Transudative chylothoraces have been reported when cirrhosis, nephrosis or heart failure co-exist. In addition, although the vast majority of the white blood cells in chyle are lymphocytes, chylothoraces can be neutrophilic, especially the postsurgical ones. SUMMARY Chylothorax is the accumulation of chyle into the pleural cavity usually due to thoracic duct leak and should be suspected not only in patients with milky effusions but also in the presence of certain co-morbidities or history of chest/neck trauma. Fluid triglycerides more than 110 mg/dl or less than 50 mg/dl virtually establish or exclude the diagnosis, respectively; ambiguous cases with values 50-110 mg/dl require lipoprotein analysis for the demonstration of chylomicrons. In fasting or malnourished patients lipoprotein analysis is suggested even with triglycerides less than 50 mg/dl. Typical pleural fluid in chylothorax is a lymphocytic exudate with low lactate dehydrogenase; atypical fluid characteristics (i.e. transudative nature, neutrophil-predominance or high lactate dehydrogenase) may be a sign of additional causes of pleural fluid accumulation.
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McGrath EE, Blades Z, Anderson PB. Chylothorax: Aetiology, diagnosis and therapeutic options. Respir Med 2010; 104:1-8. [PMID: 19766473 DOI: 10.1016/j.rmed.2009.08.010] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 07/22/2009] [Accepted: 08/07/2009] [Indexed: 01/30/2023]
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Abstract
Introduction Maternal thoracic trauma during labor is extremely rare. Case presentation A woman was presented at the Accident and Emergency Department complaining of pain over the lower thorax bilaterally which started after a difficult delivery when the obstetrician forced her lower thorax. Small right-sided haemothorax and rib fractures bilaterally were diagnosed and she was admitted to hospital. Her in-hospital stay and follow up was uneventful. Conclusion Maneuvers during labor should be applied from trained personnel and should be performed safely.
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Kouritas VK, Baloyiannis I, Desimonas N, Daponte A, Kouvaraki M, Hatzitheofilou K. Rib fractures with heamothorax after labor: a case report. CASES JOURNAL 2009; 2:8950. [PMID: 20184704 DOI: 10.1186/1757-1626-0002-0000008950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 08/14/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Maternal thoracic trauma during labor is extremely rare. CASE PRESENTATION A woman was presented at the Accident and Emergency Department complaining of pain over the lower thorax bilaterally which started after a difficult delivery when the obstetrician forced her lower thorax. Small right-sided haemothorax and rib fractures bilaterally were diagnosed and she was admitted to hospital. Her in-hospital stay and follow up was uneventful. CONCLUSION Maneuvers during labor should be applied from trained personnel and should be performed safely.
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Affiliation(s)
- Vasileios K Kouritas
- Deptartment of Surgery, Larissa University Hospital, Mezourlo 41 110, PO Box 1425, Greece.
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Lymphoscintigraphy using technetium-99m HSA-DTPA with SPECT/CT in chylothorax after childbirth. ACTA ACUST UNITED AC 2008; 26:508-11. [DOI: 10.1007/s11604-008-0265-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
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Cakir E, Gocmen B, Uyan ZS, Oktem S, Kiyan G, Karakoc F, Ersu R, Karadag B, Dagli T, Dagli E. An unusual case of chylothorax complicating childhood tuberculosis. Pediatr Pulmonol 2008; 43:611-4. [PMID: 18433047 DOI: 10.1002/ppul.20817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endobronchial tuberculosis (EBTB) and chylothorax are rare clinical disorders. The concurrence of these two disorders as manifestations of childhood pulmonary tuberculosis has not been reported. We report a 4-month-old boy presenting with chylothorax as the initial presentation of tuberculosis that has been successfully treated with octreotide, antituberculosis drugs and steroid therapy.
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Affiliation(s)
- Erkan Cakir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey.
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Honguero Martínez AF, Arnau Obrer A, Pérez Alonso D, Estors Guerrero M, Cortés Alcaide CM, Cantó Armengod A. [Bilateral Chylothorax after delivery: an infrequent case treated with videothoracoscopic talc pleurodesis]. Cir Esp 2006; 80:400-2. [PMID: 17192225 DOI: 10.1016/s0009-739x(06)70994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bilateral chylothorax after delivery is a highly infrequent entity. We present the case of a 28-year-old woman who developed progressive dyspnea due to bilateral milky pleural effusion several months after delivery. The effusion was found to contain chylomicrons in the biochemical analysis. Initial conservative treatment failed twice and the chylothorax was successfully treated through sequential bilateral videothoracoscopy with an interval of 6 days between the two interventions and pleurodesis with spray talc.
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Catanzarite V, Cousins L. RESPIRATORY FAILURE IN PREGNANCY. Radiol Clin North Am 2000. [DOI: 10.1016/s0033-8389(22)00127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Brunelli A, Catalini G, Fianchini A. Pregnancy exacerbating unsuspected mediastinal lymphangioleiomyomatosis and chylothorax. Int J Gynaecol Obstet 1996; 52:289-90. [PMID: 8775689 DOI: 10.1016/0020-7292(95)02619-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
We describe a case of chylothorax in a female patient with a large retrosternal goiter. After subtotal thyroidectomy by means of a Kocher cervicotomy, the chylothorax disappeared in 48 h. At present, 2 years after surgical removal, the patient remains asymptomatic, without recurrent pleural chylous effusion. Until now, to our knowledge, only one such case had been reported.
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Affiliation(s)
- C Delgado
- Department of General Surgery, University Valme Hospital, Sevilla, Spain
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