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Sangha H, Savolainen NG, Murrey DA, Vergnani JS. Pediatric Chylothorax Treated With Lymphangiography and Thoracic Duct Embolization: A Case Report. Cureus 2024; 16:e63981. [PMID: 39105012 PMCID: PMC11299759 DOI: 10.7759/cureus.63981] [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: 07/06/2024] [Indexed: 08/07/2024] Open
Abstract
A chylothorax, the accumulation of lymphatic fluid in the pleural space, may occur for a variety of reasons. It is commonly seen in adults post-thoracic surgery. We present the case of a seven-month-old girl with a right-sided chylothorax in the setting of non-accidental trauma. Treatment options for a chylothorax include surgical ligation of the thoracic duct or, as in this case, a minimally invasive procedure performed by interventional radiology known as lymphangiography with thoracic duct embolization. This case highlights interventional radiologists' ability to treat complex lymphatic pathologies effectively with minimally invasive techniques.
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Affiliation(s)
- Harneet Sangha
- Interventional Radiology, Elson S. Floyd College of Medicine, Spokane, USA
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2
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Li XP, Zhang Y, Sun XL, Hao K, Liu MK, Hao Q, Wang RG. Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography. World J Clin Cases 2024; 12:2350-2358. [PMID: 38765753 PMCID: PMC11099413 DOI: 10.12998/wjcc.v12.i14.2350] [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: 02/04/2024] [Revised: 03/09/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND This study presents an evaluation of the computed tomography lymphangiography (CTL) features of lymphatic plastic bronchitis (PB) and primary chylothorax to improve the diagnostic accuracy for these two diseases. AIM To improve the diagnosis of lymphatic PB or primary chylothorax, a retrospective analysis of the clinical features and CTL characteristics of 71 patients diagnosed with lymphatic PB or primary chylothorax was performed. METHODS The clinical and CTL data of 71 patients (20 with lymphatic PB, 41 with primary chylothorax, and 10 with lymphatic PB with primary chylothorax) were collected retrospectively. CTL was performed in all patients. The clinical manifestations, CTL findings, and conventional chest CT findings of the three groups of patients were compared. The chi-square test or Fisher's exact test was used to compare the differences among the three groups. A difference was considered to be statistically significant when P < 0.05. RESULTS (1) The percentages of abnormal contrast medium deposits on CTL in the three groups were as follows: Thoracic duct outlet in 14 (70.0%), 33 (80.5%) and 8 (80.0%) patients; peritracheal region in 18 (90.0%), 15 (36.6%) and 8 (80.0%) patients; pleura in 6 (30.0%), 33 (80.5%) and 9 (90.0%) patients; pericardium in 6 (30.0%), 6 (14.6%) and 4 (40.0%) patients; and hilum in 16 (80.0%), 11 (26.8%) and 7 (70.0%) patients; and (2) the abnormalities on conventional chest CT in the three groups were as follows: Ground-glass opacity in 19 (95.0%), 18 (43.9%) and 8 (80.0%) patients; atelectasis in 4 (20.0%), 26 (63.4%) and 7 (70.0%) patients; interlobular septal thickening in 12 (60.0%), 11 (26.8%) and 3 (30.0%) patients; bronchovascular bundle thickening in 14 (70.0%), 6 (14.6%) and 4 (40.0%) patients; localized mediastinal changes in 14 (70.0%), 14 (34.1%), and 7 (70.0%) patients; diffuse mediastinal changes in 6 (30.0%), 5 (12.2%), and 3 (30.0%) patients; cystic lesions in the axilla in 2 (10.0%), 6 (14.6%), and 2 (20.0%) patients; and cystic lesions in the chest wall in 0 (0%), 2 (4.9%), and 2 (4.9%) patients. CONCLUSION CTL is well suited to clarify the characteristics of lymphatic PB and primary chylothorax. This method is an excellent tool for diagnosing these two diseases.
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Affiliation(s)
- Xing-Peng Li
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Yan Zhang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250063, Shandong Province, China
| | - Xiao-Li Sun
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Kun Hao
- Department of Lymph Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Meng-Ke Liu
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Qi Hao
- Department of Radiology, People's Hospital of Peking University, The Second School of Clinical Medicine of Peking University, Beijing 100034, China
| | - Ren-Gui Wang
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
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McCormick BJ, Archana R. Left Chylothorax Without Ascites in a Liver Transplant Patient. Cureus 2024; 16:e60996. [PMID: 38916011 PMCID: PMC11194132 DOI: 10.7759/cureus.60996] [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: 05/23/2024] [Indexed: 06/26/2024] Open
Abstract
Chylothorax is a rare condition that results from thoracic duct disruption with malignant and nonmalignant etiologies manifesting as a pleural effusion. Typically, chylothorax in the setting of cirrhosis is associated with the migration of chylous ascites. We present the case of a 64-year-old male with prior liver transplant who presented with new-onset transudative chylothorax without chylous ascites who responded to transjugular intrahepatic portosystemic shunt revision, diuresis, and serial thoracentesis.
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Affiliation(s)
| | - Roy Archana
- Internal Medicine, Mayo Clinic, Jacksonville, USA
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4
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Wagenpfeil J, Hoß K, Henkel A, Kütting D, Luetkens JA, Feldmann G, Brossart P, Attenberger UI, Pieper CC. Interventional treatment of refractory non-traumatic chylous effusions in patients with lymphoproliferative disorders. Clin Exp Med 2024; 24:63. [PMID: 38554229 PMCID: PMC10981590 DOI: 10.1007/s10238-024-01312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
To report results of interventional treatment of refractory non-traumatic abdomino-thoracic chylous effusions in patients with lymphoproliferative disorders. 17 patients (10 male; mean age 66.7 years) with lymphoproliferative disorders suffered from non-traumatic chylous effusions (chylothorax n = 11, chylous ascites n = 3, combined abdomino-thoracic effusion n = 3) refractory to chemotherapy and conservative therapy. All underwent x-ray lymphangiography with iodized-oil to evaluate for and at the same time treat lymphatic abnormalities (leakage, chylo-lymphatic reflux with/without obstruction of central drainage). In patients with identifiable active leakage additional lymph-vessel embolization was performed. Resolution of effusions was deemed as clinical success. Lymphangiography showed reflux in 8/17 (47%), leakage in 2/17 (11.8%), combined leakage and reflux in 3/17 (17.6%), lymphatic obstruction in 2/17 (11.8%) and normal findings in 2/17 cases (11.8%). 12/17 patients (70.6%) were treated by lymphangiography alone; 5/17 (29.4%) with leakage received additional embolization (all technically successful). Effusions resolved in 15/17 cases (88.2%); 10/12 (83.3%) resolved after lymphangiography alone and in 5/5 patients (100%) after embolization. Time-to-resolution of leakage was significantly shorter after embolization (within one day in all cases) than lymphangiography (median 9 [range 4-30] days; p = 0.001). There was no recurrence of symptoms or post-interventional complications during follow-up (median 445 [40-1555] days). Interventional-radiological treatment of refractory, non-traumatic lymphoma-induced chylous effusions is safe and effective. Lymphangiography identifies lymphatic abnormalities in the majority of patients and leads to resolution of effusions in > 80% of cases. Active leakage is found in only a third of patients and can be managed by additional embolization.
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Affiliation(s)
- Julia Wagenpfeil
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany.
| | - Katharina Hoß
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Andreas Henkel
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Daniel Kütting
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Julian Alexander Luetkens
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Georg Feldmann
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Ulrike Irmgard Attenberger
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Claus Christian Pieper
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
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Delgado-Miguel C, Camps J, Hernandez Oliveros F. The Role of Indocyanine Green in Pediatric Gastrointestinal Surgery: Systematic Review. Eur J Pediatr Surg 2024; 34:2-8. [PMID: 37406677 DOI: 10.1055/a-2123-5433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The use of near-infrared fluorescence imaging with indocyanine green (ICG) is actually considered as a very useful tool in decision-making strategy during challenging surgical procedures with a growing evidence in the literature. Our aim is to perform a systematic review focusing on ICG applications in gastrointestinal surgery. We conducted a systematic review with narrative synthesis in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Medline, and EMBASE databases to identify articles describing the gastrointestinal perioperative use of ICG in children. We extracted data on study design, demographics, surgical indications, ICG dose, and perioperative outcomes. Eleven articles, including 94 pediatric patients, from 2013 to 2022 met the inclusion criteria for narrative synthesis in our systematic review, of which 6/11 (54.5%) were case reports, 4/11 (36.4%) were retrospective studies, and 1/11 (0.1%) were case series. Current clinical applications of ICG in gastrointestinal pediatric surgery included: esophagogastric surgery in 4/11 articles (36.4%), intestinal and pancreatic surgery in 3/11 articles (27.2%), and colorectal surgery in 4/11 articles (36.4%). ICG fluorescence in gastrointestinal pediatric surgery is a promising and safe technology that facilitates intraoperative localization of anatomical structures to achieve a more precise dissection and avoid injury to other adjacent tissues. It can be considered as a meaningful tool for assessing intestinal viability, as it provides objective data on tissue perfusion, and can impact the intraoperative decision in reconstructive surgeries requiring anastomosis. Future studies are needed to confirm these initial promising results. The lack of comparative and prospective studies is still the main limitation.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
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Bovy V, De Keukeleire T, Van Schoote E, Vanslembrouck I, Bogaert A. Post-traumatic pleural effusion: Don't forget the chylothorax! Respirol Case Rep 2024; 12:e01274. [PMID: 38188967 PMCID: PMC10768313 DOI: 10.1002/rcr2.1274] [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] [Received: 10/19/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
In this case we describe a 58-year-old male with bilateral pleural effusion after a blunt trauma to the back. A pleural puncture revealed a chylothorax. An additional computed tomography scan showed a vertebral fracture at level D8 with rupture of the nearby thoracic duct. Our patient could be treated with a conservative approach. This case highlights the importance of ruling out a chylothorax in any post-traumatic pleural effusion. Despite the low prevalence, we consider it a don't-miss diagnosis given the specific treatment requirements.
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Affiliation(s)
- Valentin Bovy
- Department of Internal MedicineAZ Sint‐Elisabeth ZottegemBelgium
| | | | - Elke Van Schoote
- Department of PneumologyAZ Sint‐Elisabeth ZottegemZottegemBelgium
| | - Inge Vanslembrouck
- Department of Internal Medicine and GeriatricsAZ Sint‐Elisabeth ZottegemZottegemBelgium
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de Villa AR, Obeidat O, Auyeung AB, Jaoude JA, Oyetoran A, Cannon K, Okonoboh P. Superior vena cava syndrome presenting as chylothorax. Radiol Case Rep 2023; 18:3824-3827. [PMID: 37663563 PMCID: PMC10474345 DOI: 10.1016/j.radcr.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Chylothorax caused by superior vena cava (SVC) syndrome is a rare but potentially life-threatening complication requiring a multidisciplinary diagnosis and management approach. We present a case of a 27-year-old female with end-stage renal disease who developed chylothorax secondary to SVC syndrome caused by venous stenosis from a tunneled hemodialysis (HD) catheter. The patient had a history of ongoing hemodialysis through a tunneled catheter placed in the right internal jugular vein approximately seven months before presentation. She presented with dyspnea, chest pain, and a large left-sided pleural effusion. A multidisciplinary diagnostic workup and management included 2 thoracentesis, pleural fluid studies, serial radiological tests, right and left heart catheterizations, and blood serum studies with flow cytometry. They revealed that SVC stenosis around the hemodialysis catheter was causing the patient's pathology. The patient underwent veno-plasty of the right SVC and brachiocephalic veins and replacement of HD catheter leading to the resolution of the chylothorax and significant improvement in respiratory symptoms. This report will highlight the approach to diagnosing and managing chylothorax and a review of existing medical literature.
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Affiliation(s)
- Ariel Ruiz de Villa
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL 32605, USA
| | - Omar Obeidat
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL 32605, USA
| | - Austin B Auyeung
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL 32605, USA
| | - Joseph Abi Jaoude
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Transitional Year Residency Program, Gainesville, FL 32605, USA
| | - Anuoluwa Oyetoran
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL 32605, USA
| | - Kristen Cannon
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL 32605, USA
| | - Peters Okonoboh
- University of Central Florida College of Medicine, Graduate Medical Education 6850 Lake Nona Blvd, Orlando, FL 32827, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL 32605, USA
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8
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Martínez Camacho RDJ, Martínez Camacho LI, Martínez Camacho D, Martínez Camacho A. Idiopathic Chylothorax During Pregnancy: A Case Report. Cureus 2023; 15:e47841. [PMID: 37899891 PMCID: PMC10611550 DOI: 10.7759/cureus.47841] [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: 10/27/2023] [Indexed: 10/31/2023] Open
Abstract
The diagnosis of chylothorax during pregnancy is rare and is generally triggered during labor. The study of pleural fluid and imaging studies can facilitate diagnosis, even though determining its etiology can be complicated. This case involves a young pregnant woman presenting with disabling dyspnea and chest pain due to pleural effusion. The conventional study of the pleural fluid was not conclusive; however, the measurement of chylomicrons guided us to determine the diagnosis of chylothorax. Based on imaging studies and specific markers, some of the main etiologies were not determined, leading to classification as idiopathic. After drainage and dietary adjustment, a significant improvement in symptoms was achieved with the help of an interdisciplinary team, which is crucial for the prevention of complications and adequate resolution of the pregnancy.
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Affiliation(s)
| | - Lilia Itzel Martínez Camacho
- Faculty of Medical and Biological Sciences "Dr. Ignacio Chávez", Universidad Michoacana de San Nicolás de Hidalgo (UMSNH), Morelia, MEX
| | - Daira Martínez Camacho
- Faculty of Medical and Biological Sciences "Dr. Ignacio Chávez", Universidad Michoacana de San Nicolás de Hidalgo (UMSNH), Morelia, MEX
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Porcel JM, Bielsa S, Civit C, Aujayeb A, Janssen J, Bodtger U, Fjaellegaard K, Petersen JK, Welch H, Symonds J, Mitchell MA, Grabczak EM, Ellayeh M, Addala D, Wrightson JM, Rahman NM, Munavvar M, Koegelenberg CF, Labarca G, Mei F, Maskell N, Bhatnagar R. Clinical characteristics of chylothorax: results from the International Collaborative Effusion database. ERJ Open Res 2023; 9:00091-2023. [PMID: 37850216 PMCID: PMC10577597 DOI: 10.1183/23120541.00091-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/14/2023] [Indexed: 10/19/2023] Open
Abstract
Background Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features. Methods The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed. Results 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL-1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL-1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L-1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL-1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. Conclusion Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.
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Affiliation(s)
- José M. Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Silvia Bielsa
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Carmen Civit
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare Foundation Trust, Cramlington, UK
| | - Julius Janssen
- Respiratory Department, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | - Katrine Fjaellegaard
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | - Jesper Koefod Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | - Hugh Welch
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jenny Symonds
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Michael A. Mitchell
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Mohamed Ellayeh
- Department of Chest Medicine, Mansoura University, Mansoura, Egypt
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dinesh Addala
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John M. Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Najib M. Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Mohammed Munavvar
- Respiratory Department, Lancashire Teaching Hospitals NHS Trust, Preston, UK
- University of Central Lancashire, Preston, UK
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Gonzalo Labarca
- Division of Internal Medicine, Complejo Asistencial Dr Víctor Ríos Ruiz, Los Angeles, Chile
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
| | - Federico Mei
- Respiratory Disease Unit, Department of Internal Medicine, University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Nyatsambo C, Moeng MS, Ngwisanyi W. A case report on chylothorax post penetrating chest trauma. Int J Surg Case Rep 2023; 110:108637. [PMID: 37572469 PMCID: PMC10428025 DOI: 10.1016/j.ijscr.2023.108637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Chylothorax is a rare condition secondary to a chyle leak from the thoracic duct. The most common cause is after thoracic and cardiac surgery. Other causes include malignancy, non-iatrogenic trauma, and miscellaneous disorder - tuberculosis, filariasis and idiopathic conditions. The incidence of chylothorax post non-iatrogenic trauma is low; however, it does occur. Therefore, clinicians managing trauma patients should be aware of chylothorax as a differential and understand how it can be managed. PRESENTATION OF CASE Our patient presented in respiratory distress 5 days after sustaining a stab to the chest. His chest X-ray showed a massive left pleural effusion with mediastinal shift. An Intercostal drain (ICD) was inserted and, drained 2 l of a white milky fluid - confirmed to be chyle on biochemistry. Other potential differentials like empyema and a pseudochylothorax, were excluded. He was kept nil-per os, received total parenteral nutrition and the ICD output was monitored. Subsequently the drainage decreased and eventually cleared, and the ICD was removed on day 8 of admission. Chest X-rays showed resolution of the effusion, and the patient was discharged. DISCUSSION Patients with trauma can present with chylothorax after penetrating or blunt trauma. The diagnosis can be made by checking the fluid triglyceride level or the presence of chylomicrons. Once the diagnosis is confirmed, the clinician should decide on either conservative or surgical. Due to the condition's rarity, there are no randomized control trials comparing different treatment modalities. CONCLUSION Despite the patient's delayed presentation, he was successfully managed conservatively.
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Affiliation(s)
- Chido Nyatsambo
- Division of Acute Care Surgery, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Chris Hani Road, Soweto, South Africa.
| | - Maeyane Steve Moeng
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
| | - Weludo Ngwisanyi
- Division of General Surgery, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
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Anger M, Hofmann J, Ruf B, Steinborn M, Reber D, Warncke K, Rieber N. Cough-induced chylothorax in a two-year-old boy - case report and review of the literature. BMC Pediatr 2023; 23:416. [PMID: 37612714 PMCID: PMC10464381 DOI: 10.1186/s12887-023-04221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chylothorax is a very rare form of pleural effusion in children, especially after the neonatal period, and predominantly occurs secondary to cardiothoracic surgery. It can lead to significant respiratory distress, immunodeficiency, and malnutrition. Effective treatment strategies are therefore required to reduce morbidity. CASE PRESENTATION A previously healthy two-year old boy was admitted with history of heavy coughing followed by progressive dyspnea. The chest X-ray showed an extensive opacification of the right lung. Ultrasound studies revealed a large pleural effusion of the right hemithorax. Pleural fluid analysis delivered the unusual diagnosis of chylothorax, most likely induced by preceded excessive coughing. After an unsuccessful treatment attempt with a fat-free diet and continuous pleural drainage for two weeks, therapy with octreotide was initiated. This led to complete and permanent resolution of his pleural effusion within 15 days, without any side effects. CONCLUSIONS Severe cough may be a rare cause of chylothorax in young children. Octreotide seems to be an effective and safe treatment of spontaneous or traumatic chylothorax in children. There is, however, a lack of comprehensive studies for chylothorax in children and many issues concerning diagnostic strategies and treatment algorithms remain.
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Affiliation(s)
- Melanie Anger
- Department of Pediatrics, Kinderklinik München Schwabing, Munich Klinik and School of Medicine, Technical University of Munich, Kölner Platz 1, 80804, Munich, Germany
| | - Julian Hofmann
- Department of Pediatrics, Kinderklinik München Schwabing, Munich Klinik and School of Medicine, Technical University of Munich, Kölner Platz 1, 80804, Munich, Germany
| | - Bettina Ruf
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marc Steinborn
- Department of Diagnostic and Interventional and Pediatric Radiology, Kinderklinik München Schwabing, Munich, Germany
| | - Daniela Reber
- Department of Pediatrics, Kinderklinik München Schwabing, Munich Klinik and School of Medicine, Technical University of Munich, Kölner Platz 1, 80804, Munich, Germany
| | - Katharina Warncke
- Department of Pediatrics, Kinderklinik München Schwabing, Munich Klinik and School of Medicine, Technical University of Munich, Kölner Platz 1, 80804, Munich, Germany
| | - Nikolaus Rieber
- Department of Pediatrics, Kinderklinik München Schwabing, Munich Klinik and School of Medicine, Technical University of Munich, Kölner Platz 1, 80804, Munich, Germany.
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12
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Jog A, Schmidt P, Hallal PL, Novitch R. Chylothorax: A Late Complication of Disseminated Mycobacterium avium Complex (MAC) Infection. Cureus 2023; 15:e40347. [PMID: 37456383 PMCID: PMC10339148 DOI: 10.7759/cureus.40347] [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: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Chylothorax is a rare cause of pleural effusion and occurs due to leakage of chyle into the pleural space. In most cases, it results from trauma, with malignancy accounting for most of the non-traumatic causes. Chylothorax resulting from immune reconstitution inflammatory syndrome (IRIS), during treatment of Mycobacterium avium complex (MAC) infection, is an extremely infrequent cause of chylothorax, with only a handful of cases reported in the literature.
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Affiliation(s)
- Abhishrut Jog
- Pulmonary Medicine, BronxCare Health System, Bronx, USA
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13
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Dung LT, Van Sy T, Linh NT, Tuyen DT, Hung DT, Van Cuong V, Nhung TH. Successful treatment of thoracic duct injury from blunt trauma. Radiol Case Rep 2023; 18:2121-2125. [PMID: 37089973 PMCID: PMC10113754 DOI: 10.1016/j.radcr.2023.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/18/2023] [Accepted: 02/26/2023] [Indexed: 04/08/2023] Open
Abstract
Chylothorax is a rare condition after blunt trauma. We present a 32-year-olds man with a thoracic duct injury resulting in the right chylothorax after a motor vehicle collision. After the failure of conservative management, the patient underwent lymphangiography and successfully embolized the thoracic duct. This report emphasizes the importance of identifying thoracic duct injury in setting blunt trauma and management of this injury.
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14
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Owda F, Mallah S, Ayyad M, Albandak M, Yousef S, Hmeedan A, Odeh M, Reid AM, Sleibi W, Azar J. A Very Uncommon Case of Transudative Chylothorax: A Case Report and Literature Review. Cureus 2023; 15:e38320. [PMID: 37261168 PMCID: PMC10227672 DOI: 10.7759/cureus.38320] [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: 04/29/2023] [Indexed: 06/02/2023] Open
Abstract
The presence of chyle in the pleural cavity is referred to as chylothorax. Exudative chylothorax is usually related to damage or obstruction of the lymphatic vasculature with subsequent leakage into the pleural space. In contrast, transudative chylothorax is related to increased hydrostatic pressure caused by elevated intra-abdominal pressure, which leads to the translocation of chylous fluid into the pleural space. Cirrhosis is the most common cause of transudative chylothorax, commonly presenting with ascites and portal hypertension. To the best of our knowledge, isolated transudative chylothorax as a consequence of cirrhosis is exceptionally rare and has been scarcely reported in the literature. We herein report a female patient in her fifties who presented to our hospital with isolated unilateral transudative hepatic chylothorax, with no clinical evidence of cirrhosis or any stigmata of portal hypertension at the time of presentation.
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Affiliation(s)
- Fahed Owda
- Internal Medicine, An-Najah National University, Nablus, PSE
| | - Shatha Mallah
- Internal Medicine, An-Najah National University, Nablus, PSE
| | | | | | - Shahed Yousef
- School of Medicine, Al-Quds University, Jerusalem, PSE
| | - Alaa Hmeedan
- Internal Medicine, An-Najah National University, Nablus, PSE
| | - Mahmoud Odeh
- Internal Medicine, An-Najah National University, Nablus, PSE
| | - Adam M Reid
- Research, University of California Los Angeles, California, USA
| | - Wadi Sleibi
- Internal Medicine, Al-Quds University, Jerusalem, PSE
| | - Jehad Azar
- Respiratory Institute, Cleveland Clinic, Cleveland, USA
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15
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Huan NC, Tan HA, Ramarmuty HY, Ponnuvelu S, Letcheminan S, Sivaraman Kannan KK. Pleural fluid milkshakes: three cases with different aetiologies. Respirol Case Rep 2023; 11:e01116. [PMID: 36910134 PMCID: PMC9995641 DOI: 10.1002/rcr2.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
In clinical practice, chylothorax is usually suspected in any patient with milky pleural fluid. However, contrary to popular belief, milky appearance of pleural fluid is seen in less than half of patients with chylothorax. A high index of suspicion for chylothorax is therefore needed in any turbid, bloody, or serosanguinous effusions of unclear aetiology. In this case series, we present three patients with biochemically proven chylothorax: each with a different presentation, pleural fluid appearance, underlying cause, management strategy and clinical outcome. The first patient developed 'milky' chylothorax secondary to lymphoma while the second patient's 'yellow' chylothorax is related to pleural tuberculosis. The final patient suffered from 'pink' chylothorax in the setting of systemic amyloidosis. In each of the cases, prompt diagnosis of chylothorax followed by efforts to elucidate the underlying cause are crucial steps to guide subsequent management with the main aim to ensure a better clinical outcome.
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Affiliation(s)
- Nai-Chien Huan
- Department of Respiratory Medicine Queen Elizabeth Hospital Kota Kinabalu Malaysia
| | - Hooi Ann Tan
- Department of Respiratory Medicine Queen Elizabeth Hospital Kota Kinabalu Malaysia
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16
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Response to Provenzano et al. and De Carlo et al. J Thorac Oncol 2023; 18:e13-e14. [PMID: 36682841 DOI: 10.1016/j.jtho.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/22/2023]
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17
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Muacevic A, Adler JR, Hu J, Zaher S, Arabian S, Hasan M, Vo D. Left-Sided Transudative Chylothorax With Concomitant Chylous Ascites in the Setting of Liver Cirrhosis. Cureus 2023; 15:e33866. [PMID: 36819322 PMCID: PMC9933419 DOI: 10.7759/cureus.33866] [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: 01/17/2023] [Indexed: 01/18/2023] Open
Abstract
Most chylothoraces are caused by trauma and malignancy, and pleural fluid analysis typically demonstrates an exudative effusion. Transudative chylothorax is a rare manifestation and has only been cited in case reports in the current literature. Here, we present the case of a 59-year-old male with a history of liver cirrhosis secondary to alcohol abuse, chronic kidney disease stage 3a, and hypertension who presented with a left-sided pleural effusion and abdominal ascites. A thoracentesis and abdominal paracentesis were performed, and fluid analyses demonstrated a transudative chylothorax with concomitant chylous ascites. In this review, we aim to highlight a rare case of transudative chylothorax and discuss the pathogenesis and management of this condition.
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18
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Warrior K, Dilling DF. Lung transplantation for lymphangioleiomyomatosis. J Heart Lung Transplant 2023; 42:40-52. [PMID: 36334961 DOI: 10.1016/j.healun.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease, associated with respiratory symptoms of dyspnea and spontaneous pneumothorax, along with various extra-thoracic manifestations. Often a progressive disease, albeit slowly, patients can develop chronic and severe respiratory failure and require supplemental oxygen. Lung transplantation (LTX) can offer improved duration and quality of life for patients with end-stage lung disease due to LAM. There are several unique considerations for LTX in LAM patients, and disease-specific complications of LAM prior to LTX can affect management decisions. Furthermore, there are several possible post-transplant issues specific to LAM. In this review, we discuss evaluation and management, disease-specific complications (both pre- and post-transplant), and outcomes for LAM patients undergoing lung transplantation.
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Affiliation(s)
- Krishnan Warrior
- Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - Daniel F Dilling
- Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
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19
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Yang Q, Bai X, Bao H, Li Y, Men W, Lv L, Liu Z, Han X, Li W. Invasive treatment of persistent postoperative chylothorax secondary to thoracic duct variation injury: Two case reports and literature review. Medicine (Baltimore) 2022; 101:e31383. [PMID: 36316910 PMCID: PMC9622594 DOI: 10.1097/md.0000000000031383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Postoperative chylothorax is a rare complication after pulmonary resection. Thoracic duct variations may play a key role in postoperative chylothorax occurrence and make treatment difficult. No studies in the literature have reported the successful treatment of chylothorax second to thoracic duct variation by lipiodol-based lymphangiography. PATIENT CONCERNS A 63-year-old male and a 28-year-old female with primary lung adenocarcinoma were treated by video-assisted thoracoscopic cancer resection, and suffered postoperative chylothorax. Conservative treatment was ineffective, including nil per os, persistent thoracic drainage, fatty food restriction, and somatostatin administration. DIAGNOSIS Postoperative chylothorax. INTERVENTIONS Patients received lipiodol-based lymphangiography under fluoroscopic guidance. Iatrogenic injuries were identified at thoracic duct variations, including an additional channel in case 1 and the lymphatic plexus instead of the thoracic duct in case 2. OUTCOMES Thoracic duct variations were identified by lipiodol-based lymphangiography, and postoperative chylothorax was successfully treated by lipiodol embolizing effect. LESSONS Thoracic duct variations should be considered after the failure of conservative treatment for postoperative chylothorax secondary to pulmonary resection. Lipiodol-based lymphangiography is valuable for identifying the thoracic duct variations and embolizing chylous leakage.
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Affiliation(s)
- Qiwei Yang
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xu Bai
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Han Bao
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yukang Li
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wanfu Men
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ling Lv
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhenghua Liu
- Department of Thorax, 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
- *Correspondence: Xiangjun Han, Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China (e-mail: )
| | - Wenya Li
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
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20
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Muacevic A, Adler JR. Chylothorax After Schwannoma Resection. Cureus 2022; 14:e30112. [PMID: 36381836 PMCID: PMC9643697 DOI: 10.7759/cureus.30112] [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] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Schwannomas are tumors derived from Schwann cells of the peripheral nerve sheath that are usually benign; nonetheless, they can cause significant morbidity. When indicated, surgical resection is the gold standard of treatment for schwannomas. However, chylothorax is a rare postoperative complication of thoracic surgery. We present a case of chylothorax after thoracic schwannoma resection. A 61-year-old woman underwent a computed tomography (CT) scan for suspected nephrolithiasis, which instead found a right mediastinal mass that was confirmed to have features consistent with a schwannoma on thoracic spine magnetic resonance imaging (MRI). Right thoracotomy and schwannoma resection were performed, resulting in the complete removal of the schwannoma without capsular invasion. Two chest tubes were also inserted. On postoperative day 1 (POD1), the patient presented with a chylothorax that was initially treated with chest tube suctioning and total parenteral nutrition (TPN). However, a repeat right thoracotomy with thoracic duct ligation and dry talc chemical pleurodesis was subsequently performed on POD15 due to a lack of clinical improvement, which saw the resolution of the chylothorax without recurrence. Chylothorax is a rare but severe postoperative complication of thoracic surgeries, including those that involve tumor resections. We present a case of chylothorax after thoracic schwannoma resection that initially failed conservative management but eventually resolved after thoracic duct ligation and chemical pleurodesis. This case highlights the need for effective non-surgical treatments for chylothorax, the importance of remaining vigilant for rare postoperative complications, and the need for randomized controlled trials (RCTs) to develop a standardized chylothorax management algorithm.
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21
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Strama KL, Rice TD, Ruff JP, Carter KE, Ernst NE, Kuebel DJ, Droege ME. Octreotide Dosing in the Medical Management of Chyle Leak Following Otolaryngologic, Thoracic, and Trauma Surgery: A 9-Year Evaluation. J Pharm Pract 2022. [DOI: 10.1177/08971900221125831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Chyle leak is a rare complication following otolaryngologic, thoracic, and trauma surgery wherein the thoracic duct is transected. Case reports and small case series describe octreotide for the medical management of chyle leak, but limited data exist to determine the ideal dose. Objective: To evaluate octreotide dosing in patients with acute chyle leak. Methods: This retrospective, single center, cohort study evaluated adult patients admitted to the otolaryngology, cardiothoracic, and trauma surgery teams over a 9-year period. Patients diagnosed with a chyle leak who received octreotide were eligible for inclusion. Groups were defined as successful medical management or failure requiring definitive surgery. The primary endpoint was daily octreotide dose between groups. Results: Forty-seven patients were included with 29 (61.7%) admitted to the otolaryngology service and 44 (93.6%) with surgical complication as the chyle leak cause. Thirty-two (68.1%) patients had successful medical management while 15 (31.9%) patients failed and required surgical intervention. There was no difference in median daily octreotide dose (250 [IQR, 170-288] µg vs 253 [IQR, 200-282] µg, P = .9). Octreotide weight-based dose, treatment duration, and route of administration were similar between groups. Daily drain output and complete bowel rest were significantly higher in the failure group. Daily drain output was identified as an independent risk factor for failure. Conclusion: Octreotide dose was similar in patients with and without successful medical management of chyle leak. Future studies are needed to determine optimal octreotide dosing and elucidate the relationship between octreotide, drain output, and surgical intervention need.
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Affiliation(s)
- Kelly L. Strama
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Timothy D. Rice
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jacob P. Ruff
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
| | - Kristen E. Carter
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Neil E. Ernst
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Dalton J. Kuebel
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Molly E. Droege
- Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- Department of Pharmacy Services, UC Health – University of Cincinnati Medical Center, Cincinnati, OH, USA
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22
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Abhinay A, Singh A, Rajniti P, Mishra OP. Response to Chemical Pleurodesis in Children with Frequent Relapsing Nephrotic Syndrome Having Refractory Unilateral Pleural Effusion. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:726-729. [PMID: 37955464 DOI: 10.4103/1319-2442.389432] [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: 11/14/2023] Open
Abstract
Idiopathic nephrotic syndrome is one of the most common chronic renal disorders in children. Associated bilateral pleural effusion is common due to the transudative process as a result of hypoalbuminemia. However, unilateral pleural effusion is a rare phenomenon and at times, unresponsive even when the patients are in remission. Here, we report two cases of frequent relapse nephrotic syndrome presented as persistent unilateral pleural effusion responsive to chemical pleurodesis, which was done with bleomycin along with normal saline.
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Affiliation(s)
- A Abhinay
- Department of Pediatrics, Division of Pediatric Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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23
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Pippard B, Bhatnagar M, McNeill L, Donnelly M, Frew K, Aujayeb A. Hepatic Hydrothorax: A Narrative Review. Pulm Ther 2022; 8:241-254. [PMID: 35751800 PMCID: PMC9458779 DOI: 10.1007/s41030-022-00195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/01/2022] [Indexed: 12/10/2022] Open
Abstract
Hepatic hydrothorax (HH) represents a distinct clinical entity within the broader classification of pleural effusion that is associated with significant morbidity and mortality. The median survival of patients with cirrhosis who develop HH is 8-12 months. The diagnosis is typically made in the context of advanced liver disease and ascites, in the absence of underlying cardio-pulmonary pathology. A multi-disciplinary approach to management, involving respiratory physicians, hepatologists, and palliative care specialists is crucial to ensuring optimal patient-centered care. However, the majority of accepted therapeutic options are based on expert opinion rather than large, adequately powered randomized controlled trials. In this narrative review, we discuss the epidemiology, pathophysiology, clinical characteristics, and management of HH, highlighting the use of salt restriction and diuretic therapy, porto-systemic shunts, and liver transplantation. We include specific sections focusing on the role of pleural interventions and palliative care, respectively.
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Affiliation(s)
- Benjamin Pippard
- Department of Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Malvika Bhatnagar
- Department of Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Lisa McNeill
- Department of Hepatology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mhairi Donnelly
- Department of Hepatology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katie Frew
- Department of Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Avinash Aujayeb
- Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, Northumbria Way, Northumberland, Cramlington, NE23 6NZ, UK.
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24
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Sun JD, Shum T, Behzadi F, Hammer MM. Imaging Findings of Thoracic Lymphatic Abnormalities. Radiographics 2022; 42:1265-1282. [PMID: 35960666 DOI: 10.1148/rg.220040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The lymphatic system plays an important role in balancing fluid compartments in the body. It is disrupted by various disease processes in the thorax, including injury to the thoracic lymphatic duct after surgery, as well as malignancy and heart failure. Because of the small size of lymphatic vessels, imaging of the lymphatics is relatively difficult, and effective imaging methods are still being optimized and developed. The standard of reference for lymphatic imaging has been conventional lymphangiography for several decades. Other modalities such as CT, noncontrast or contrast-enhanced MRI, and lymphoscintigraphy can also demonstrate lymphatic abnormalities and help in treatment planning. Imaging findings associated with lymphatic abnormalities can be seen in the pulmonary parenchyma, pleural space, and mediastinum. In the pulmonary parenchyma, common findings include interlobular septal thickening as well as reversal of lymphatic flow with intravasation of contrast material into pulmonary lymphatics. In the pleural space, findings include chylous pleural effusion and occasionally nonchylous pleural effusion. In the mediastinum, thoracic duct leak, plexiform thoracic duct, lymphatic malformations, and lymphangiectasis may occur. Management of chylothorax includes conservative or medical treatment, surgery, and interventional radiology procedures. The authors discuss thoracic lymphatic anatomy, imaging manifestations of lymphatic abnormalities in the various anatomic compartments, and interventional radiology treatment of chylothorax. Radiologists should be familiar with these imaging findings for diagnosis and to help guide appropriate management. ©RSNA, 2022.
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Affiliation(s)
- Jingshuo Derek Sun
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Thomas Shum
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Fardad Behzadi
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Mark M Hammer
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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25
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Management of lymphoma-associated chylothorax by interventional radiology and chemotherapy: a report of five cases. Int J Hematol 2022; 116:579-585. [PMID: 35819710 DOI: 10.1007/s12185-022-03397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Chylous effusion is associated with lymphatic obstruction or leakage in mediastinal or abdominal lymph nodes, and is a rare but troublesome complication in patients with malignant lymphomas. Although there is no standard of care, it is often treated with simultaneous chemotherapeutic and non-chemotherapeutic interventions. Here, we describe the cases of five patients with lymphoma-associated chylothorax with the aim of clarifying an effective treatment strategy. All patients achieved a partial response or better for lymphoma. All patients underwent interventional radiology (IVR) procedures, including lymphangiography (LAG) and thoracic duct embolization (TDE). Complete resolution of chylothorax was eventually achieved by IVR procedures or pleurodesis in all patients. No patients experienced serious adverse events related to LAG/TDE. Treatment of chylous effusion required months for most patients (range: 0.2-4.8 months). Our data suggest that a combination of chemotherapy and LAG/TDE is effective for refractory lymphoma-related chylous effusion.
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26
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Abstract
True bilateral spontaneous chylothorax without any etiology has been reported rarely in the pediatric literature. A 3-year-old male child was detected to have incidental moderate chylothorax on USG thorax done for scrotal swelling. Investigations for infectious, malignant, cardiac, and congenital etiology were unremarkable. Effusion was drained by securing bilateral intercostal drains (ICD) and confirmed to be chyle on biochemical evaluation. The child was discharged with ICD in situ, but there was non-resolution of bilateral pleural effusion. Because of the failure of conservative treatment, video-assisted thoracoscopy (VATS) with pleurodesis was done. Thereafter, the child improved symptomatically and was discharged. On follow-up, there is no recurrence of pleural effusion, and the child has been growing well, albeit the etiology remains elusive. Chylothorax should not be missed in children presenting with scrotal swelling. In children with spontaneous chylothorax, VATS should be done after a fair trial of conservative medical management (thoracic drainage) along with continued nutritional management. How to cite this article Kaul A, Fursule A, Shah S. An Unusual Presentation of Spontaneous Chylothorax. Indian J Crit Care Med 2022;26(7):871-873.
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Affiliation(s)
- Amita Kaul
- Department of Neonatal and Pediatric Intensive Care, Surya Mother and Child Super Speciality Hospital, Pune, Maharashtra, India
| | - Anurag Fursule
- Department of Neonatal and Pediatric Intensive Care, Surya Mother and Child Super Speciality Hospital, Pune, Maharashtra, India,Anurag Fursule, Department of Neonatal and Pediatric Intensive Care, Surya Mother and Child Super Speciality Hospital, Pune, Maharashtra, India, e-mail:
| | - Sachin Shah
- Department of Neonatal and Pediatric Intensive Care, Surya Mother and Child Super Speciality Hospital, Pune, Maharashtra, India
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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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Lymphatic Interventions in the Cancer Patient. Curr Oncol Rep 2022; 24:1351-1361. [PMID: 35639331 DOI: 10.1007/s11912-022-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The incidence of lymphatic leakage (iatrogenic and non-iatrogenic) is growing in cancer population due to the increased complexity of the surgical procedures and improved overall survival in cancer patients. The purpose of this article is to review the contemporary approach in the field of percutaneous lymphatic embolization in cancer patients with lymphatic leaks. RECENT FINDINGS Since the advent of intranodal lymphangiography in 2011 alongside with the MR and CT lymphangiography, the accuracy of diagnosis of the lymphatic diseases has significantly improved significantly. These advancements have triggered a revival of minimally invasive lymphatic interventions. Lymphatic embolization is expanding from the classic indication, thoracic duct embolization, to other lymphatic disorders (chylous ascites, lymphoceles, liver lymphorrhea, protein-losing enteropathy). The growth of lymphatic research and the standardization of the lymphatic interventions require a multidisciplinary and collaborative approach between physicians and researchers.
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The Development of Chylothorax in a Child With T-cell Lymphoblastic Lymphoma and Ataxia Telangiectasia During Induction Therapy. J Pediatr Hematol Oncol 2022; 44:e554-e556. [PMID: 33370001 DOI: 10.1097/mph.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
Chylothorax is an unusual complication of childhood cancer. It causes to additional morbidity and mortality during management. It should be kept in mind that chylothorax may occur due to mass shrinkage during treatment in patients with mediastinal mass and ductus thoracicus invasion at the initial diagnosis and necessary measures should be taken. This case was presented because of the rarity in pediatric oncology practice.
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Erattengal H, Nandish C. Hodgkin's lymphoma in a milky way. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_120_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sabang RL, Esteves A, Mathew J, Ahmed T, Epelbaum O. Double trouble: Biochemically confirmed bilateral chylothorax with positive pleural fluid cytology due to breast adenocarcinoma. Respir Med Case Rep 2022; 38:101700. [PMID: 35859612 PMCID: PMC9289731 DOI: 10.1016/j.rmcr.2022.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/16/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
Although chylothorax is a well-described complication of malignancy, especially lymphoma, breast adenocarcinoma has not been a commonly implicated primary tumor. There has been only one published report of biochemically confirmed bilateral chylothorax in solid malignancy, and this was not associated with breast adenocarcinoma. Likewise, there has been only one published report of bilateral chylothorax in solid malignancy with positive pleural fluid cytology on both sides; again, the primary tumor was not breast adenocarcinoma. Herein we present a case that combines all three of these rarely reported features: a patient with metastatic breast adenocarcinoma who developed biochemically confirmed bilateral chylothorax with documented positive pleural fluid cytology on both sides. This report is accompanied by a literature review of published cases of bilateral chylothorax in solid malignancy.
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Affiliation(s)
- Ralph Llewel Sabang
- Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
- Corresponding author. Department of Internal Medicine, Westchester Medical Center, 100 Woods Road Room 1042, Valhalla, NY, 10595, USA.
| | - Andre Esteves
- Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Jeffy Mathew
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Tauseef Ahmed
- Division of Hematology and Oncology, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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Transudative chylothorax in a liver cirrhosis patient: A case report. Respir Med Case Rep 2022; 39:101731. [PMID: 36051238 PMCID: PMC9425071 DOI: 10.1016/j.rmcr.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Chylothorax defines chyle in the pleural space, usually from defects in thoracic duct. Chylothoraces are usually exudative, as defined by light's criteria but in rare instances, chylothoraces can be transudative. The leading cause of non-traumatic chylothorax is malignancy, but a non-traumatic chylothorax can be a rare manifestation of liver cirrhosis. In this case report, we present a case of an 82-year-old male with a history of non-alcoholic liver cirrhosis requiring multiple paracenteses for chylous ascites in the past, who was found to have a transudative non-traumatic chylothorax. His chylothorax existed despite his ascites being resolved for over a year. We will describe this case of a transudative chylothorax associated with liver cirrhosis and discuss the common findings associated with chylothoraces.
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Bradt N, Olbrechts F, Alexander P, Salembier A. A Dasatinib-Induced Chylothorax Persisting After the Discontinuation of Dasatinib. Eur J Case Rep Intern Med 2022; 9:003601. [PMID: 36415836 PMCID: PMC9678124 DOI: 10.12890/2022_003601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 03/24/2023] Open
Abstract
UNLABELLED Dasatinib is a second-generation tyrosine kinase inhibitor with activity on the BCR-ABL fusion gene. It is used in the treatment of BCR-ABL positive chronic myeloid leukaemia and has the known side effect of pleural effusion. This usually involves exudate with the presence of lymphocytes. A more uncommon side effect is the development of a chylothorax. We describe a case of a 67-year-old man with chronic myeloid leukaemia, for which treatment with dasatinib, with the presence of a right-sided chylothorax. The man presented at an outpatient consultation due to complaints of exertional dyspnoea. Radiographic imaging showed the presence of a right-sided pleural effusion. Several punctures were performed with an evacuation of 4,900 mL bloody chylous fluid in total. Each puncture revealed an increased concentration of triglycerides on the fluid, hence confirming a recurring chylothorax. A pleurodesis was performed as a final therapy. Bosutinib was substituted for dasatinib eight months prior to initial admission, making this the first reported persisting dasatinib-induced chylothorax after discontinuation. The pathophysiology has not yet been fully elucidated; it is suspected to involve an interaction on the PDGFR-β pathway. LEARNING POINTS Dasatinib is a rare cause of chylothorax.Chylothorax should be included in the differential diagnosis in patients developing pleural effusions when treated with dasatinib.The cornerstone of the treatment is tapering the dose or discontinuing the dasatinib therapy and changing it to another tyrosine kinase inhibitor.
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Affiliation(s)
- Nicolas Bradt
- Department of Internal Medicine, AZ Glorieux, Ronse, Belgium
- Department of Internal Medicine, UZ Gent, Gent, Belgium
| | - Frederic Olbrechts
- Department of Internal Medicine, AZ Glorieux, Ronse, Belgium
- Department of Internal Medicine, UZ Leuven, Leuven, Belgium
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Non-Traumatic Chylothorax and Chylopericardium: Diagnosis and Treatment Using an Algorithmic Approach Based on Novel Lymphatic Imaging. Ann Am Thorac Soc 2021; 19:756-762. [PMID: 34797746 DOI: 10.1513/annalsats.202103-262oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Outcomes of interventional lymphangiographic treatment of nontraumatic chylous pleural effusions using traditional approaches have been highly variable. Recent advances in lymphatic imaging have revealed variations in underlying pathophysiology enabling improved targeting of therapeutic interventions. OBJECTIVE To assess outcomes of an algorithm for management of nontraumatic chylous pleural effusions based on advanced MR identification of various abnormalities in the thoracoabdominal lymphatic network that give rise to chylothorax. METHODS Novel lymphatic MR imaging was performed in 52 patients ages 11 to 89 years. Three distinct pathophysiological patterns were found: (1) abnormal pulmonary lymphatic flow from the thoracic duct only; (2) abnormal pulmonary lymphatic flow from retroperitoneal lymphatic networks with or without involvement of the thoracic duct; and (3) chylous ascites presenting as chylous pleural effusion. Lymphatic interventions were individualized to the underlying pathophysiological patterns. RESULTS In 41/52 (79%) patients, imaging revealed abnormal pulmonary lymphatic flow from the thoracic duct and/or retroperitoneal lymphatic networks. Thoracic duct embolization and/or interstitial embolization of retroperitoneal lymphatic resulted in resolution of chylothorax in this group in 38/41 (93%) of those patients. Five patients experienced Grade 1 or 2 complications. One patient succumbed to post-operative stress-induced cardiomyopathy and pulmonary embolism. Chylous ascites was the cause of chylothorax in 11/52 (21%) patients. Eight chose to undergo interventions for chylous ascites with clinical success in 6/8 (75%). CONCLUSIONS Application of MRI-guided intervention algorithm resulted in successful control of non-traumatic chylothorax in 93% patients with abnormal pulmonary lymphatic flow. Appropriate treatment of chylous ascites presenting as a pleural effusion requires systematic evaluation and diagnosis prior to potential treatments.
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Ito K, Hachisu Y, Shibasaki M, Ezawa K, Iwashita H, Jingu A, Arai H, Horie T, Takise A. Liver Cirrhosis and Hepatocellular Carcinoma Diagnosed from Chylothorax: A Case Report. Clin Pract 2021; 11:582-586. [PMID: 34563002 PMCID: PMC8482157 DOI: 10.3390/clinpract11030073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023] Open
Abstract
A 71-year-old man visited our hospital with dyspnea and left pleural effusion. Left pleural effusion was diagnosed as chylothorax by thoracentesis. He had no history of trauma or surgery, and there were no findings of malignant lymphoma or thrombosis. Furthermore, he was diagnosed with liver cirrhosis and hepatocellular carcinoma by computed tomography and hematological examinations, and the chylothorax was considered to be caused by liver cirrhosis. We report a review of the literature with this case since it is relatively rare for cirrhosis and hepatocellular carcinoma diagnosed from chylothorax.
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Affiliation(s)
- Kenta Ito
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
- Department of Gastroenterology, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (M.S.); (H.A.)
| | - Yoshimasa Hachisu
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
- Correspondence: ; Tel.: +81-272-653-333
| | - Mitsuhiko Shibasaki
- Department of Gastroenterology, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (M.S.); (H.A.)
| | - Kazuma Ezawa
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
| | - Hiroshi Iwashita
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
| | - Asuka Jingu
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
| | - Hirotaka Arai
- Department of Gastroenterology, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (M.S.); (H.A.)
| | - Takeo Horie
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
| | - Atsushi Takise
- Department of Respiratory Medicine, Maebashi Red Cross Hospital, 389-1, Asakura-Machi, Maebashi 371-0811, Japan; (K.I.); (K.E.); (H.I.); (A.J.); (T.H.); (A.T.)
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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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Paul T, Ellahie AY, Almohtasib YS, Sinha U, El Omri H. Dasatinib‐induced chylothorax: An unusual presentation of a common adverse event—A case report with literature review. EJHAEM 2021; 2:545-550. [PMID: 35844702 PMCID: PMC9175909 DOI: 10.1002/jha2.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are the key agents for treating CML and BCR–ABL+ B‐ALL. Dasatinib is a potent second‐generation TKI. Here, we have discussed the case of a 51‐year‐old gentleman diagnosed with B‐myeloid mixed‐phenotype acute leukemia with t(9;22)(q34.1;q11.2); BCR–ABL1p210, in complete hematological, cytogenetic, and molecular remission, who developed chylothorax. Though pleural effusion is a commonly observed adverse effect of dasatinib therapy, chylothorax is rare. The ability of Dasatinib to inhibit multiple families of tyrosine kinases could be considered the etiology. Discontinuation of the drug resolved the symptom, but pleural effusion recurred once Dasatinib was resumed. Chylothorax induced by Dasatinib is a differential to be kept in mind, owing to the limited number of cases being reported.
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Affiliation(s)
- Theresa Paul
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Anil Yousaf Ellahie
- Department of Hematology National Centre for Cancer Care and Research Doha Qatar
| | | | - Urshita Sinha
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Halima El Omri
- Department of Hematology National Centre for Cancer Care and Research Doha Qatar
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Do TVC, Cozza J, Ganti S, Depa J. Recurrent Chylous Ascites Leading to Transudative Chylothorax Due to Bi-Ventricular Heart Failure. J Investig Med High Impact Case Rep 2021; 9:23247096211026144. [PMID: 34148400 PMCID: PMC8221665 DOI: 10.1177/23247096211026144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chylothorax is a pleural effusion of >110 mg/dL of triglycerides with a milky appearance with transudative being rare. In this article, we present a case of transudative chylothorax with concurrent chylous ascites that is secondary to congestive heart failure (CHF). A 70-year-old male with CHF with ejection fraction of 10%, coronary artery disease status post coronary artery bypass graft, sleep apnea, chronic kidney disease stage 3, and chronic obstructive pulmonary disease presented with worsening abdominal distention, shortness of breath, and increased lower extremities edema. He denied any cough or fever but had orthopnea and paroxysmal nocturnal dyspnea. He requires monthly paracentesis with drainage of 5 to 9 L each time. On physical examination, he had crackles bilaterally with no wheezes or jugular venous distension. His cardiac examination was unremarkable. He did have abdominal distension with dullness to percussion and a positive fluid wave. There was +2 bilateral pitting edema of lower extremities. He had a diagnostic paracentesis where 9.2 L of cloudy milky fluid was drained and therapeutic thoracentesis where 1.1 L of milky fluid was drained. Pleural fluid for triglycerides was 280. His peritoneal fluid had triglycerides of 671 confirming chylous ascites. CHF can lead to chylous ascites due to the increased lymph production in the abdomen, which flows to the thoracic duct. Due to the stiffness at the lymphatic junction, there is high pressure for less flow. The diaphragm plays a role allowing the chylous ascites to be absorb into the thorax.
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Affiliation(s)
- Tuong Vi Cassandra Do
- Appalachian Regional Healthcare, Internal Medicine Residency Program, Harlan, KY, USA
| | - Justin Cozza
- Appalachian Regional Healthcare, Internal Medicine Residency Program, Harlan, KY, USA
| | - Shyam Ganti
- Appalachian Regional Healthcare, Internal Medicine Residency Program, Harlan, KY, USA
| | - Jayaramakrishna Depa
- Appalachian Regional Healthcare, Internal Medicine Residency Program, Harlan, KY, USA
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Ahuja J, de Groot PM, Shroff GS, Strange CD, Vlahos I, Rajaram R, Truong MT, Wu CC. The postoperative chest in lung cancer. Clin Radiol 2021; 77:6-18. [PMID: 34154835 DOI: 10.1016/j.crad.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.
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Affiliation(s)
- J Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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40
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Stange S, Sziklavari Z. [Modern Treatment Options for Postoperative Chylothorax: a Systematic Review]. Pneumologie 2021; 75:439-446. [PMID: 34116575 DOI: 10.1055/a-1172-7288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chylothorax is a multifactorial complication, usually caused by surgery or traumatic injury, and more rarely by malignant disease. Because of the lack of prospective, randomised trials, the evidence-based treatment rests upon personal experience, but ideally taking into account retrospective analysis. MATERIAL AND METHODS The aim of this review is to provide a comprehensive overview of the currently available modern treatment options. Another aspect is to show their advantages and disadvantages. For this purpose, a literature search was performed using the "PubMed" database. Publications older than ten years were excluded from this review. The literature search employed the keyword "chylothorax". The priority was set on publications including a comparative assessment of treatment approaches. The authors relied on many years of clinical experience to critically analyse and evaluate the treatment options and the given recommendations. RESULTS The success rate of the conservative treatment methods ranges widely, depending on the underlying cause of the disease (3-90 %). Non-invasive or semi-invasive procedures are successful in 50 to 100 % of the cases, also depending on the aetiology. After unsuccessful conservative treatment of operable patients, the standard surgical therapy consists of thoracic duct ligature, which is usually performed thoracoscopically. Alternatively, pleurodesis or the placement of a permanent chest drain (PleurX) or a pleuroperitoneal shunt may be performed. The success rate of these procedures is between 64 and 100 %. The morbidity and mortality rate can reach values up to 25 %. CONCLUSION Treatment of a chylothorax should be started conservatively. Subsequently, a more aggressive therapy may be gradually considered, based on the patient's health and the amount of the secretion. Interventional radiological procedures are safe, successful, and have a legitimate place alongside conservative or surgical treatment. However, they are currently only available in some larger centres.
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Affiliation(s)
- S Stange
- Klinik für Thoraxchirurgie, Regiomed Kliniken GmbH, Sonneberg/Coburg
| | - Z Sziklavari
- Klinik für Thoraxchirurgie, Regiomed Kliniken GmbH, Sonneberg/Coburg
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Hsu C, Hsu J, Wu K. Dasatinib-induced chylothorax in a patient with chronic myeloid leukaemia: a case report and literature review. Respirol Case Rep 2021; 9:e00753. [PMID: 33976882 PMCID: PMC8103079 DOI: 10.1002/rcr2.753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Dasatinib is a potent and effective second-generation oral tyrosine kinase inhibitor that is clinically indicated for the treatment of imatinib-resistant or imatinib-intolerant breakpoint cluster region-Abelson (BCR-ABL)-positive chronic myeloid leukaemia (CML) or for Philadelphia chromosome-positive acute lymphocytic leukaemia. The most common adverse events associated with dasatinib therapy are skin rash, gastrointestinal upset, pancytopenia, pulmonary hypertension, and fluid retention, including pleural effusion. However, chylothorax secondary to dasatinib administration has rarely been reported. Although the underlying mechanism leading to dasatinib-induced chylothorax is uncertain, the preferred treatment options are usually supported with diuretics or systemic steroids. Moreover, the discontinuation of the drug is mandatory in refractory cases. Here, we present the case of a patient with dasatinib-induced chylothorax, and review the previously reported cases in the literature.
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Affiliation(s)
- Chao‐Chin Hsu
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Jui‐Feng Hsu
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Kuan‐Li Wu
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
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Wiesner S, Loch E, Uller W, Gößmann H, Neu R, Hofmann HS, Ried M. Evaluation of treatment options for postoperative and spontaneous chylothorax in adults. Interact Cardiovasc Thorac Surg 2021; 33:527-533. [PMID: 34000033 DOI: 10.1093/icvts/ivab127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Both postoperative and spontaneous chylothorax remain therapeutic challenges without recommendations for a standardized treatment approach. Regardless of its aetiology, patients with chylothorax experience prolonged hospitalization and suffer from the associated complications or the invasive therapy administered. METHODS We conducted a retrospective, observational review of adult patients with chylothorax treated between January 2010 and September 2019. The primary end point was successful management with sustained cessation and/or controlled chylous output. Therapy duration, inpatient stay and the incidence of complications were evaluated as secondary end points. RESULTS Of the 36 patients included (22 men; median age 63 years), 24 patients (67%) suffered from a postoperative accumulation of chylous fluid in the pleural space; in the remaining 12 (33%) patients, chylothoraces occurred spontaneously. Initial conservative treatment was successful in 42% (n = 15); in the other 20 cases (56%) additional invasive therapeutic strategies were followed. A complicated course requiring more than 1 treatment was seen in 54% (n = 13) of the postoperative and in 58% (n = 7) of the spontaneous cases. The median length of hospitalization was significantly longer in the postoperative group (37.5 vs 15.5 days; P = 0.016). Serious complications were observed only in the postoperative group (P = 0.28). There were no in-hospital deaths. CONCLUSIONS Basic treatment of both postoperative and spontaneous chylothorax should include dietary measures in all patients. Additional sclerosing radiotherapy and interventional or surgical therapy are often necessary. The choice of therapeutic approach should be indicated, depending on the aetiology and development of the chylothorax. Early, multimodal treatment is recommended.
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Affiliation(s)
- Sigrid Wiesner
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Holger Gößmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Gary P, Gianniosis M, Ryu J, Flynn S. Chylothorax as a complication of Waldenström macroglobulinaemia with a patient's perspective. BMJ Case Rep 2021; 14:14/5/e241707. [PMID: 33962927 PMCID: PMC8108664 DOI: 10.1136/bcr-2021-241707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chylothorax has rarely been reported as a pleuropulmonary complication of Waldenström macroglobulinaemia (WM). In general, when a unilateral effusion is discovered particularly in patients with a history of cancer or active malignancy, a broad differential including chylothorax needs to be considered. We present the case of a 50-year-old woman found to have chylothorax secondary to progression of WM as confirmed by cytology and presence of MYD88 L265P mutation in the pleural fluid specimen and subsequent resolution with chemotherapy. This review centres particularly on non-traumatic causes of chylothorax with a focus on WM and includes a unique patient perspective.
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Affiliation(s)
- Phillip Gary
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA .,Pulmonary and Critical Care, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Jay Ryu
- Pulmonary, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Samantha Flynn
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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Zaalouk TM, Bitar ZI, Maadarani OS, Ragab Elshabasy RD. Modified BLUE protocol ultrasonography can diagnose thrombotic complications of COVID-19 with normal lung ultrasound. Clin Case Rep 2021; 9:e04075. [PMID: 34084496 PMCID: PMC8142407 DOI: 10.1002/ccr3.4075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/12/2022] Open
Abstract
The BLUE protocol provides an excellent step-by-step approach for diagnosis of acute dyspnea. Adding FECHO (Focused Echocardiography) to the BLUE protocol completes the picture and helps make solid diagnoses, especially in submassive and massive PE (Pulmonary embolism). COVID-19 infection can present with thrombotic manifestations like DVT (Deep vein thrombosis) and PE with no ultrasonographic evidence of lung parenchymal affection.
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45
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A 67-Year-Old Woman With Abdominal Pain and Dyspnea. Chest 2021; 159:e309-e312. [PMID: 33965154 DOI: 10.1016/j.chest.2020.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/05/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
CASE PRESENTATION A 67-year-old woman presented to her primary physician with a year of periumbilical abdominal discomfort with diarrhea, bloating, and unintentional weight loss. While undergoing workup for the abdominal pain, she presented to the ED with dyspnea that worsened over a few weeks. She had no associated chest pain, lower extremity edema, fevers, or chills, but endorsed orthopnea. The patient's medical history included hypothyroidism and diabetes mellitus. Her family history was significant for coronary disease in her father and hypertension in her mother. She had no recent travel; she is a nonsmoker and rare alcohol drinker. She worked in administration.
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Thoracic Empyema Secondary to Congenital Chylothorax in a 14-Month-Old Boy with Noonan Syndrome. Case Rep Pediatr 2021; 2021:6620353. [PMID: 34012687 PMCID: PMC8105093 DOI: 10.1155/2021/6620353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/23/2021] [Indexed: 12/10/2022] Open
Abstract
Thoracic empyema usually occurs as a complication of bacterial pneumonia, but in rare cases, it is caused by hematogenous dissemination secondary to nonpulmonary diseases. Congenital chylothorax or chylothorax in children is associated with maldevelopment of the lymphatic system, nonimmune hydrops fetalis, several syndromes including Down syndrome, Noonan syndrome, or Turner syndrome, a complication of thoracic surgery, right heart failure with high central venous pressure, or tumors. There are very few reports of empyema associated with preexisting chylothorax. In the present study, we describe a rare case of thoracic empyema associated with congenital chylothorax and supravalvular pulmonary stenosis associated with clinically diagnosed Noonan syndrome. It is necessary to closely monitor patients with chylothorax because they are at risk of developing severe lung infections, such as pleural empyema or lung abscesses.
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Shaikh DH, Gongati S, Salman SH, Reyes OA, Chilimuri S. Peritoneal Lymphomatosis: The Great Mimicker. Cureus 2021; 13:e14508. [PMID: 34007761 PMCID: PMC8121203 DOI: 10.7759/cureus.14508] [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] [Indexed: 11/05/2022] Open
Abstract
Peritoneal lymphomatosis (PL) is defined as intraperitoneal dissemination of lymphoma. Although rare, it is associated with high-grade lymphomas and can be easily mistaken for peritoneal carcinomatosis (PC) on imaging, which is a common condition associated with gastrointestinal and gynecological malignancies. Both PL and PC share similar radiographic features, however, they differ considerably in terms of prognosis and management. We present a case of a 58-year-old male with abdominal distention and ascites, initially reported as having PC on imaging. A subsequent peritoneal biopsy revealed PL secondary to a low-grade follicular lymphoma. Since PL responds well to chemotherapy, its prompt diagnosis and differentiation from PC helps avoid unnecessary surgery.
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48
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Yadav A, Jain Y, Narkhede A, KM M, Gupta A. Lymphangiography and Lymphatic Interventions. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1726165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractCompared with the traditional pedal lymphangiography, intranodal lymphangiography and MR lymphangiography have made imaging of the lymphatic system less challenging. Improvements in imaging and availability of newer catheters have allowed embolization of lymphatic system much more feasible that previously envisioned. In this article, we briefly review the anatomy, imaging, and current and future of lymphatic interventions.
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Affiliation(s)
- Ajit Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Yajush Jain
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Mahendra KM
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
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49
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Jeon YJ, Cho JH, Hyun D, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM. Management of chyle leakage after general thoracic surgery: Impact of thoracic duct embolization. Thorac Cancer 2021; 12:1382-1386. [PMID: 33783956 PMCID: PMC8088932 DOI: 10.1111/1759-7714.13914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 01/30/2023] Open
Abstract
Background The aim of this study was to investigate the impact of thoracic duct embolization (TDE) on the management of postoperative chyle leakage. Methods We retrospectively reviewed the electronic medical record database of 4171 patients who underwent curative resection for lung or esophageal cancer between January 2015 and June 2017. We classified the period before the introduction of TDE as the first period and the period after the introduction of TDE as the second period. Results A total of 105 patients who developed chyle leakage after surgery were included. In the first period, 49 patients who underwent lung surgery developed chylothorax. Of those, two patients (4.1%) underwent surgical ligation of the thoracic duct (TD). Of eight patients with chyle leakage after esophagectomy, four patients (50%) underwent TD ligation. In the second period, 30 patients developed postoperative chyle leakage after pulmonary resection. Only one (3.3%) of them required surgical ligation. Of eight patients with chyle leakage after esophagectomy, only two (11.1%) patients underwent TD ligation. Five patients (16.7%) received TDE after lung surgery and five patients (27.7%) after esophageal surgery. Also, in the second period, the hospital stay of patients who underwent lung cancer surgery was shorter than the first period (12.6 ± 4.6 days vs. 16.3 ± 9.7 days; p = 0.026). Conclusions TDE is an effective method for the management of chyle leakage and might help to avoid invasive surgery.
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Affiliation(s)
- Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bauer PK, Flicker M, Fabian E, Flick H, Brcic L, Liegl-Atzwanger B, Janisch M, Fuchsjäger M, Olschewski H, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 170: A 33-year-old psychologist with severe dyspnea and right-sided chylothorax. Wien Klin Wochenschr 2021; 133:65-72. [PMID: 33119872 PMCID: PMC7840639 DOI: 10.1007/s00508-020-01753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Martin Flicker
- Department of Internal Medicine, State Hospital Hochsteiermark, Leoben, Austria
| | - Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Michael Janisch
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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