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Rocha G, Arnet V, Soares P, Gomes AC, Costa S, Guerra P, Casanova J, Azevedo I. Chylothorax in the neonate-A stepwise approach algorithm. Pediatr Pulmonol 2021; 56:3093-3105. [PMID: 34324269 DOI: 10.1002/ppul.25601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. METHODS An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. DISCUSSION AND CONCLUSION The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vanessa Arnet
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Gomes
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Paula Guerra
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Casanova
- Department of Cardiothoracic Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Azevedo
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,EPIUnit, Public Health Institution, University of Porto, Porto, Portugal
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Huang XM, Luo M, Ran LY, You XH, Wu DW, Huang SS, Gong Q. Chylothorax following posterior low lumbar fusion surgery: A case report. World J Clin Cases 2021; 9:6522-6530. [PMID: 34435021 PMCID: PMC8362579 DOI: 10.12998/wjcc.v9.i22.6522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/15/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery; however, it is one of the rare complications in orthopedic surgery. This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery. The etiology, diagnosis, and treatment were analyzed and discussed.
CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain. She was diagnosed with L4 degenerative spondylolisthesis, L4/L5 and L5/S1 intervertebral disc herniation and L5 instability, and underwent successful posterior L4-S1 instrumentation and fusion surgery. Unfortunately, thoracic effusion was identified 2 d after operation. The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests. The patient was discharged after 12-d persisting drainage, 3-d total parenteral nutrition and fasting, and other supportive treatments. No recurring symptoms were observed within 12 mo follow-up.
CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion. Comprehensive diagnosis and treatment of chylothorax are necessary. Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.
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Affiliation(s)
- Xian-Ming Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ming Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Yu Ran
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xuan-He You
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Di-Wei Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shi-Shu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Quan Gong
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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