1
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Toptan HH, Ozalkaya E, Karadag N, Topcuoglu S, Dincer E, Karatekin G. Neonatal Lymphatic Flow Disorder. Indian J Pediatr 2024; 91:248-253. [PMID: 37040015 DOI: 10.1007/s12098-023-04531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To examine and discuss patients diagnosed with acquired and congenital chylothorax in the neonatal period in the light of the literature. METHODS The files of newborns followed-up in the neonatal intensive care unit (NICU) and diagnosed with congenital and acquired chylothorax were reviewed retrospectively. Patients with isolated chylothorax were classified as Group 1 and those with multiple lymphatic flow disorders were classified as Group 2. Antenatal and clinical features were recorded and compared between the groups. RESULTS Thirteen infants were diagnosed with chylothorax; 92.3% (n = 12) of the patients were congenital. The rate of antenatal diagnosis was 61.5% (n = 8). Eight patients (61.5%) were diagnosed with hydrops fetalis. Among the cases in Group 1 and Group 2, receiving ocreotide and the incidence of sepsis (p = 0.05) were partially significant. Seven of the patients (66.6%) responded to medium chain triglycerides (MCT), and complete resolution was seen in 6 (85.7%) of the responders. Complete resolution of chylothorax fluid was observed in 7 (77.7%) of nine patients who responded to ocreotide treatment. CONCLUSIONS In neonatal chylothorax, the postnatal period includes a multidisciplinary approach that requires drug therapy, dietary modifications, drainage of pleural fluid, and rarely, surgery.
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Affiliation(s)
- Handan Hakyemez Toptan
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey.
| | - Elif Ozalkaya
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Nilgun Karadag
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Emre Dincer
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Guner Karatekin
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
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2
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Ehsan L, Thoe JA, Parent JJ, Fakhoury JD. Chylothorax related to acute SARS-CoV-2 infection in a patient with Noonan syndrome with prior uncomplicated cardiac surgeries. Cardiol Young 2024; 34:448-451. [PMID: 38131139 DOI: 10.1017/s1047951123004171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
SARS-CoV-2 is a novel coronavirus that has rarely been associated with chylothorax. Patients with Noonan syndrome are at risk for developing chylothorax, especially after cardiothoracic interventions. We present the case of SARS-CoV-2 infection triggering the underlying tendency of a patient with Noonan syndrome to develop chylothorax who did not develop it even after prior cardiothoracic interventions. Patient presented in respiratory distress without hypoxia and was found, on imaging, to have a large right-sided pleural effusion, which was eventually classified as chylothorax. The patient was then started on a low-fat diet. Chest tube drainage substantially reduced the effusion in size, and it remained stable. Our report highlights that SARS-CoV-2 infection can cause the development of a chylothorax or a chylous effusion in patients with Noonan syndrome or among populations with a similar predisposition. A high index of suspicion in vulnerable patients or those not responding to traditional therapy should exist with providers, thus leading to the testing of the fluid to confirm the diagnosis.
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Affiliation(s)
- Lubaina Ehsan
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D, School of Medicine, Kalamazoo, MI, USA
| | - Jessica A Thoe
- Division of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John J Parent
- Division of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph D Fakhoury
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D, School of Medicine, Kalamazoo, MI, USA
- Pediatric Hospital Medicine, Bronson Children's Hospital, Kalamazoo, MI, USA
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3
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Ellebrecht DB, Hoge M, von Weihe S. [Chylothorax]. Zentralbl Chir 2024; 149:133-147. [PMID: 38442889 DOI: 10.1055/a-1990-4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Chylothorax is a serious and potentially life-threatening condition of diverse etiology. This article provides a detailed overview of anatomy, physiology, etiology, diagnosis, and therapeutic options in the context of chylothorax.
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4
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Ng BH, Ban AYL, Nik Abeed NN, Abdul Hamid MF. Recurrent bilateral idiopathic chylothorax: a therapeutic challenge. BMJ Case Rep 2023; 16:e258049. [PMID: 38103910 PMCID: PMC10728944 DOI: 10.1136/bcr-2023-258049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Chylothorax is a rare condition caused by pleural effusion resulting from thoracic duct injury. Recurrent chylothorax is often resistant to conservative treatment and presents a clinical conundrum in its management. Here, we report a compelling case of recurrent chylothorax that persisted despite the administration of total parenteral nutrition, octreotide and thoracic duct embolisation. The patient eventually required thoracic duct ligation and talc pleurodesis, which resulted in the resolution of the effusion. Our case is an illustrative example of the effective multidisciplinary management of recurrent bilateral idiopathic chylothorax.
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Affiliation(s)
- Boon Hau Ng
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Yu-Lin Ban
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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5
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Wongrukmit S, Ngamphaiboon N, Kiranantawat K, Suwanthanma W, Plumworasawat S, Boonsakan P, Pongtippan A, Phanachet P, Warodomwichit D, Shantavasinkul PC. Unusual manifestation of gastric adenocarcinoma presenting with lymphedema, chylothorax, and chylous ascites. Clin J Gastroenterol 2023; 16:822-828. [PMID: 37737943 DOI: 10.1007/s12328-023-01851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
A 62-year-old Thai man with a 2-year history of bilateral lymphedema and an unprovoked left axillary vein thrombosis presented with progressive leg, scrotal, and abdominal swelling, and shortness of breath. He denied any gastrointestinal symptoms. His lymphedema had initially been diagnosed as chronic filariasis due to positive blood tests for anti-filarial antibodies; however, treatment with anti-filarial drugs failed to improve his symptoms. Subsequently, he underwent surgical lymphaticovenular anastomosis with scrotal reduction, which proved to be of limited symptomatic relief. Later investigations revealed bilateral chylothorax and chylous ascites, with the presence of metastatic adenocarcinoma. Histopathological examination of the patient's skin and scrotum biopsy from his previous surgery revealed invasion of the lymphatics by neoplastic cells with signet ring cell formation. Gastroscopy uncovered a gastric mass, and biopsy confirmed the diagnosis of stage IV gastric adenocarcinoma with signet ring cell. He later received palliative chemotherapy. For the management of chyle leakage, he was prescribed a very low-fat diet and supplemented with parenteral nutrition. Despite treatment, he developed cutaneous metastasis and was transitioned to best supportive care. The patient passed away 14 months after diagnosis.
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Affiliation(s)
- Siree Wongrukmit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Nuttapong Ngamphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kidakorn Kiranantawat
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Suwanthanma
- Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirithep Plumworasawat
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Atcharaporn Pongtippan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pariya Phanachet
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Daruneewan Warodomwichit
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
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6
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Fogg KL, Trauth A, Horsley M, Vichayavilas P, Winder M, Bailly DK, Gordon EE. Nutritional management of postoperative chylothorax in children with CHD. Cardiol Young 2023; 33:1663-1671. [PMID: 36177859 DOI: 10.1017/s1047951122003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Chylothorax after congenital cardiac surgery is associated with increased risk of malnutrition. Nutritional management following chylothorax diagnosis varies across sites and patient populations, and a standardised approach has not been disseminated. The aim of this review article is to provide contemporary recommendations related to nutritional management of chylothorax to minimise risk of malnutrition. METHODS The management guidelines were developed by consensus across four dietitians, one nurse practitioner, and two physicians with a cumulative 52 years of experience caring for children with CHD. A PubMed database search for relevant literature included the terms chylothorax, paediatric, postoperative, CHD, chylothorax management, growth failure, and malnutrition. RESULTS Fat-modified diets and nil per os therapies for all paediatric patients (<18 years of age) following cardiac surgery are highlighted in this review. Specific emphasis on strategies for treatment, duration of therapies, optimisation of nutrition including nutrition-focused lab monitoring, and supplementation strategies are provided. CONCLUSIONS Our deliverable is a clinically useful guide for the nutritional management of chylothorax following paediatric cardiac surgery.
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Affiliation(s)
- Kristi L Fogg
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Amiee Trauth
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Megan Horsley
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Melissa Winder
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - David K Bailly
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Erin E Gordon
- Department of Pediatrics, Division of Pediatric Critical Care, University of Texas Southwestern, Dallas, TX, USA
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7
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Kovesi T, Rojas SK, Boycott KM. Persistent chylothorax associated with lymphatic malformation type 6 due to biallelic pathogenic variants in PIEZO1. Am J Med Genet A 2023; 191:2188-2192. [PMID: 37159433 DOI: 10.1002/ajmg.a.63237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
PIEZO1 is required for lymphatic valve formation, and several lymphatic abnormalities have been reported to be associated with autosomal recessive PIEZO1 pathogenic variants including neonatal hydrops, lymphedema involving various body regions, and chylothorax. Persistent or recurrent chylothorax has been infrequently described in association with pathogenic variants in the PIEZO1 gene. We present a 4-year-old female with bilateral pleural effusions detected prenatally, who was diagnosed with bilateral chylothoraces post-partum. She subsequently had recurrent pleural effusions involving both pleural cavities, which tended to improve with restriction of her fat intake, and, one occasion, subcutaneous octreotide. She also had bilateral calf, and intermittent cheek swelling. Genetic testing revealed two deleterious variants in PIEZO1: c.2330-2_2330-1del and c.3860G > A (p.Trp1287*), both of which were classified as likely pathogenic. This supported a diagnosis of Lymphatic Malformation Type 6 (OMIM 616843), also known as Hereditary Lymphedema Type III. Hereditary Lymphedema type III can be associated with persistent chylothorax that can vary in size over time.
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Affiliation(s)
- Thomas Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Eastern Ontario, Canada
| | - Samantha K Rojas
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Eastern Ontario, Canada
| | - Kym M Boycott
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Eastern Ontario, Canada
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8
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Vangara A, Haroon M, Kalafatis K, Kolagatla S, Ganti S, Prevatt O. Chylothorax in the Setting of Lung Malignancy. J Investig Med High Impact Case Rep 2023; 11:23247096231192876. [PMID: 37565692 PMCID: PMC10422884 DOI: 10.1177/23247096231192876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Chylothorax refers to chyle within the pleural space, which frequently arises from an interruption in the thoracic duct or because of reduced lymphatic drainage. Pleural fluid that is white/milky in appearance, with a triglyceride concentration of greater than 110 mg/dL, strongly supports the diagnosis of chylothorax. Chylothorax is nearly always exudative. Transudative chylothorax is extremely rare and typically presents due to a secondary cause, such as liver cirrhosis, nephrotic syndrome, or congestive heart failure. We present a case of chylothorax that occurs in the setting of lung adenocarcinoma. A 65-year-old African American man with a past medical history of metastatic right lung adenocarcinoma presented with dyspnea and palpitations. He denied fever, orthopnea, and paroxysmal nocturnal dyspnea. Therapeutic drainage of the left pleural effusion resulted in 650 mL of milky-white fluid. Pleural fluid analysis demonstrated a triglyceride concentration of 520 mg/dL, a pleural/serum protein ratio of 0.41, a pleural/serum lactate dehydrogenase (LDH) ratio of 0.26, a total pleural LDH of 127 IU/L, and a cholesterol level of 58 mg/dL. This effusion can be classified as transudative as per Light's criteria and exudative as per Heffner's and pleural cholesterol criteria. A subsequent pleural fluid cytology found malignant cells consistent with lung adenocarcinoma. Malignancy is the most common cause of nontraumatic, exudative chylothorax. Light's criteria misinterpret about 25% of transudative effusions as exudative. Therefore, to minimize this error, a combination of the 3-criterial consideration is ideal.
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Affiliation(s)
- Avinash Vangara
- Appalachian Regional Healthcare Internal Medicine Residency Program, Harlan, KY, USA
| | - Moeez Haroon
- Appalachian Regional Healthcare Internal Medicine Residency Program, Harlan, KY, USA
| | | | - Sandhya Kolagatla
- Appalachian Regional Healthcare Internal Medicine Residency Program, Whitesburg, KY, USA
| | - SubramanyaShyam Ganti
- Appalachian Regional Healthcare Internal Medicine Residency Program, Harlan, KY, USA
| | - Opal Prevatt
- Appalachian Regional Healthcare Internal Medicine Residency Program, Harlan, KY, USA
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9
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Agrawal A, Chaddha U, Kaul V, Desai A, Gillaspie E, Maldonado F. Multidisciplinary Management of Chylothorax. Chest 2022; 162:1402-1412. [PMID: 35738344 DOI: 10.1016/j.chest.2022.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 12/14/2022] Open
Abstract
Chylothorax, the accumulation of chyle in the pleural space, is usually caused by the disruption of the thoracic duct or its tributaries. Etiologies are broadly divided into traumatic, including postsurgical, and nontraumatic, most commonly in the setting of malignancy. The management of chylothorax largely depends on the cause and includes dietary modification and drainage of the pleural space. A definitive intervention, whether surgical or a percutaneous lymphatic intervention, should be considered in patients with a persistently high volume of chylous output and in those with a prolonged leak, before complications such as malnutrition ensue. No methodologically robust clinical trials guiding management are currently available. In this article, we review the current literature and propose a stepwise, evidence-based multidisciplinary approach to the management of patients with both traumatic and nontraumatic chylothorax.
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Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology, Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.
| | - Udit Chaddha
- Interventional Pulmonology, Division of Pulmonary, Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Viren Kaul
- Division of Pulmonary and Critical Care Medicine, Crouse Health/SUNY Upstate Medical University, Syracuse, NY
| | - Ajinkya Desai
- Interventional Radiology, Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Erin Gillaspie
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Fabien Maldonado
- Interventional Pulmonology, Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
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10
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Gheorghe M, Achim F, Hoara P, Constantin A, Constantinoiu S. Management of Chylothorax in Esophageal Surgery by Minimally Invasive Thoracoscopic Approach: Case Series. Chirurgia (Bucur) 2022; 117:230-236. [PMID: 35535786 DOI: 10.21614/chirurgia.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
Abstract
Chylothorax is a rare complication, especially after esophageal cancer surgery. It may occur mainly in the thoracic stage of esophagectomy. The management of chylothorax is usually conservative, surgical reoperation with thoracic duct ligation being reserved for those cases refractory to that treatment. We discuss issues of diagnosis and therapeutic attitude, as evidenced by the literature, although a general consensus has not been established, most likely due to the low frequency of this complication. We emphasize the minimally invasive thoracoscopic approach, as it has been applied for two cases with this type of complication. A high rate of suspicion for thoracic duct injury should be maintained in all patients after esophageal surgery, with any pleural effusion entering the differential diagnosis of chylothorax.
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11
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Samanidis G, Kourelis G, Bounta S, Kanakis M. Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery-Current Aspects in Diagnosis and Treatment. Nutrients 2022; 14:nu14091803. [PMID: 35565771 PMCID: PMC9104302 DOI: 10.3390/nu14091803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022] Open
Abstract
Postoperative chylothorax is a rare complication following cardiac surgery for congenital heart disease (CHD) in the pediatric population, including neonates and infants. Multiple mechanisms are involved in the development of postoperative chylous effusions, mainly the traumatic injury of lymphatic vessels, systemic venous obstruction and dysfunction of the right ventricle. In this review, we focus on the existing evidence regarding the definition and diagnosis of postoperative chylothorax in children with CHD, as well as current therapeutic approaches, both nutritional and interventional, for the management of these patients. As part of nutritional management, we specifically comment on the use of defatted human milk and its effect on both chylothorax resolution and patient growth. A consensus with regard to several key aspects of this potentially significant complication is warranted given its impact on the cost, morbidity and mortality of children with CHD.
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Affiliation(s)
- Georgios Samanidis
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Department of Pediatric and Adult Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
- Correspondence:
| | - Georgios Kourelis
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.K.); (S.B.)
| | - Stavroula Bounta
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.K.); (S.B.)
| | - Meletios Kanakis
- Department of Pediatric and Adult Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
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12
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van Schaik CJ, Janssen JJ, van der Vleuten CJM, Te Loo MWM, Schultze Kool LJ, Klein WM. [Disorders of the central lymphatic system]. Ned Tijdschr Geneeskd 2022; 166:D6190. [PMID: 35499508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The central lymphatic system consists of the thoracic duct, cisterna chyli and the retroperitoneal lymphatics through which lymph and chyle flows. Disorders of the central lymphatic system can for instance lead to leakage (chylothorax), accumulation of fluid (lymphedema) and retrograde flow (protein losing enteropathy). Abnormalities in the central lymphatic system were overlooked for years, followed by lack of diagnostic and therapeutic options. This has changed, as the technique of intranodal contrast injection in inguinal lymph nodes brought renewed interest in the central lymphatic system. In this article, the importance of intranodal contrast injection in diagnosis and treatment of disorders of the central lymphatic system will be presented through 3 clinical cases.
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13
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Parshin VD, Saliba MB, Anokhina VM, Bolotskaya AA, Kryuchkova KY, Parshin AV. [Surgery for chyloptysis]. Khirurgiia (Mosk) 2022:120-125. [PMID: 35593636 DOI: 10.17116/hirurgia2022051120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chyloptysis is a rare disease characterized by formation of bronchial casts containing chyle and repeating bronchial tree branching. The authors report a 56-year-old woman with chyloptysis accompanied by cough and expectoration of milky bronchial casts, as well several episodes of asphyxia. Stages of diagnosis and successful treatment including thoracic duct ligation and skeletonization of the root of the left lung are described. The authors also analyze literature data on etiology, pathogenesis and feasibility of conservative and surgical treatment of these patients.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M B Saliba
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V M Anokhina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Bolotskaya
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K Yu Kryuchkova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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14
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Elsayed S, Gohar A, Jamous F. Brief Review of Chylothorax Diagnosis and Management: Making the Case for Substance Over Appearance. S D Med 2021; 74:434-439. [PMID: 34461681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chylothorax is the presence of a chylous effusion in the pleural space. Diagnosing chylothorax requires a high clinical suspicion, awareness of the different appearances of a chylothorax and the performance of tests on the pleural fluid, additional to those typically required to differentiate an exudate from a transudate based on Light's criteria. Chylothorax is a more common diagnosis in the trauma and post-surgical patients, but it is still important for practitioners of other disciplines to be aware of it. In this article we provide a concise summary of chylothorax diagnosis and management.
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Affiliation(s)
| | - Ahmed Gohar
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fady Jamous
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Pulmonary and Sleep Medicine, Avera Medical Group, Sioux Falls, South Dakota
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15
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Sakata K, Kikuchi J, Emoto K, Kotaki T, Ota Y, Nishina N, Hanaoka H, Otomo K, Suzuki K, Kaneko Y, Takeuchi T. Refractory IgG4-related Pleural Disease with Chylothorax: A Case Report and Literature Review. Intern Med 2021; 60:2135-2143. [PMID: 33518567 PMCID: PMC8313917 DOI: 10.2169/internalmedicine.6313-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We herein report a rare case of a 66-year-old man with refractory chylothorax. Although he had been treated with moderate doses of prednisolone (PSL) on suspicion of pleuritis with Sjögren syndrome, the pleural effusion expanded after the reduction of PSL. Further workup including histopathological examinations of pleura led to the diagnosis of IgG4-RD with bilateral chylothorax without any leakage from the thoracic duct. Combination therapy with high-dose PSL plus rituximab successfully decreased the pleural effusion. This is a very rare case of IgG4-related pleuritis with chylothorax and the first report of its successful treatment with rituximab.
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Affiliation(s)
- Komei Sakata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Katsura Emoto
- Division of Diagnostic Pathology, Keio University School of Medicine, Japan
| | - Tomomi Kotaki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yuichiro Ota
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Naoshi Nishina
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Kotaro Otomo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
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Tessier A, Boutaud L, Bruel AL, Thauvin-Robinet C, Roth P, Malan V, Beaujard MP, Achaiaa A, de Oliveira J, Steffann J, Encha-Razavi F, Faivre L, Bessières B, Attié-Bitach T. Hydrothorax in fetal cases of Opitz G/BBB diagnosis: Extending the phenotype? Clin Genet 2020; 98:620-621. [PMID: 32926417 DOI: 10.1111/cge.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
We report two fetal cases carrying a de novo MID1 mutation and presenting with severe hydrothorax, suggesting the expansion of the phenotype of Opitz GBBB syndrome.
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Affiliation(s)
- Aude Tessier
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR 1163, Université de Paris, Imagine Institute, Paris, France, Paris, France
| | - Lucile Boutaud
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR 1163, Université de Paris, Imagine Institute, Paris, France, Paris, France
| | - Ange-Line Bruel
- UMR1231, Université Bourgogne, Dijon, France
- Centre de Génétique, CHU Dijon Bourgogne, Dijon, France
| | - Christel Thauvin-Robinet
- UMR1231, Université Bourgogne, Dijon, France
- Centre de Génétique, CHU Dijon Bourgogne, Dijon, France
| | - Philippe Roth
- Département d'obstétrique et de médecine fœtale, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Valérie Malan
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR 1163, Université de Paris, Imagine Institute, Paris, France, Paris, France
| | - Marie-Paule Beaujard
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Amale Achaiaa
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Judite de Oliveira
- Service de génétique moléculaire, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Julie Steffann
- INSERM UMR 1163, Université de Paris, Imagine Institute, Paris, France, Paris, France
- Service de génétique moléculaire, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Ferechte Encha-Razavi
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurence Faivre
- UMR1231, Université Bourgogne, Dijon, France
- Centre de Génétique, CHU Dijon Bourgogne, Dijon, France
| | - Bettina Bessières
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR 1163, Université de Paris, Imagine Institute, Paris, France, Paris, France
| | - Tania Attié-Bitach
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR 1163, Université de Paris, Imagine Institute, Paris, France, Paris, France
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17
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Bailey J, Florence J. Cloudy Pleural Fluid on Thoracentesis. Am Fam Physician 2020; 102:307-308. [PMID: 32866355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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18
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D'Amours G, Brunel-Guitton C, Delrue MA, Dubois J, Laberge S, Soucy JF. Prenatal pleural effusions and chylothorax: An unusual presentation for CM-AVM syndrome due to RASA1. Am J Med Genet A 2020; 182:2454-2460. [PMID: 32776686 DOI: 10.1002/ajmg.a.61779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Guylaine D'Amours
- Service de Génétique Médicale, CHU Sainte-Justine, Montréal, Canada
- Faculté de Médecine, Université de Montréal, Montréal, Canada
| | | | - Marie-Ange Delrue
- Service de Génétique Médicale, CHU Sainte-Justine, Montréal, Canada
- Département de Pédiatrie, Université de Montréal, Montréal, Canada
| | - Josée Dubois
- Département d'Imagerie Médicale, CHU Sainte-Justine, Montréal, Canada
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Université de Montréal, Montréal, Canada
| | - Sophie Laberge
- Département de Pédiatrie, Université de Montréal, Montréal, Canada
- Service de Pneumologie, CHU Sainte-Justine, Montréal, Canada
| | - Jean-François Soucy
- Service de Génétique Médicale, CHU Sainte-Justine, Montréal, Canada
- Département de Pédiatrie, Université de Montréal, Montréal, Canada
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Szkorupa M. Postoperative chylothorax review. Rozhl Chir 2020; 99:427-437. [PMID: 33242960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The spectrum of causes of chylothorax is wide, including an injury to the thoracic duct in various thoracosurgical procedures, especially in esopha-geal, lung and heart surgery. Late diagnosis or inadequate treatment of chylothorax still has a high rate of morbidity and mortality. This is mainly related to high losses of chyle which is rich in minerals, plasma proteins, fats and lymphocytes. The most serious effects are mineral breakdown, malnutrition and immunodeficiency. Early diagnosis and adequate therapy are essential. The strategy is based on the type of primary operation, the volume of chyle secretion and its duration. The authors present an overview of the issue of chylothorax from its etiology of origin to its anatomy, physiology, pathophysiology, symptomatology, diagnosis and therapy.
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Ingraham BS, Sawatsky AP. 70-Year-Old Man With Fatigue, Shortness of Breath, and Bilateral Lower Extremity Edema. Mayo Clin Proc 2019; 94:e137-e143. [PMID: 31685263 DOI: 10.1016/j.mayocp.2019.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 05/01/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Brenden S Ingraham
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Adam P Sawatsky
- Advisor to resident and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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21
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Rodríguez-Hidalgo LA, Concepción-Urteaga LA, Cornejo-Portella JL, Alquizar-Horna ON, Aguilar-Villanueva DA, Concepción-Zavaleta MJ, Ruiz-Caballero DC. A case report of tuberculous chylothorax. Medwave 2019; 19:e7655. [PMID: 31348771 DOI: 10.5867/medwave.2019.05.7655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/15/2019] [Indexed: 02/08/2023] Open
Abstract
Tuberculous chylothorax is a rare infectious disease that occurs when the thoracic duct is obstructed. Treatment is directed to the tuberculosis infection. A 55-year-old male, driver, born in Trujillo (Peru) is admitted to the emergency department with increasing dyspnea and a 5-day dry cough. The physical examination revealed vocal fremitus, dullness to percussion, and a vesicular murmur that was decreased on the lower 2/3 of the left hemithorax. The X-ray and the thoracic ultrasound revealed significant left pleural effusion. The thoracocentesis drained fluid identified as chylothorax. Subsequently, a thoracic tube was placed, with a decrease in pleural fluid volume and later normalization of the cytochemical changes. Diagnostic video bronchoscopy was performed with a bronchoalveolar aspirate, revealing acid-fast bacilli. The patient received antituberculosis treatment with a favorable outcome. Tuberculous chylothorax is an important cause of chylothorax to be considered in endemic areas of tuberculosis. Proper treatment of the infection leads to resolution of the disease.
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Affiliation(s)
- Luis Alejandro Rodríguez-Hidalgo
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Centro de Excelencia para el Manejo de Tuberculosis Luz Caviedes Rojas, Hospital Regional Docente de Trujillo, Trujillo, Perú. Address: Manzana A Lote 1-M, Urbanización Los Portales del Golf, Víctor Larco, Trujillo, Perú. Email;
| | - Luis Alberto Concepción-Urteaga
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Centro de Excelencia para el Manejo de Tuberculosis Luz Caviedes Rojas, Hospital Regional Docente de Trujillo, Trujillo, Perú
| | - Jorge Luis Cornejo-Portella
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Centro de Excelencia para el Manejo de Tuberculosis Luz Caviedes Rojas, Hospital Regional Docente de Trujillo, Trujillo, Perú
| | - Oscar Neri Alquizar-Horna
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Centro de Excelencia para el Manejo de Tuberculosis Luz Caviedes Rojas, Hospital Regional Docente de Trujillo, Trujillo, Perú
| | | | | | - Diana Cecilia Ruiz-Caballero
- Centro de Excelencia para el Manejo de Tuberculosis Luz Caviedes Rojas, Hospital Regional Docente de Trujillo, Trujillo, Perú
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De Angelis LC, Bellini T, Witte MH, Kylat RI, Bernas M, Boccardo F, Paladini D, Magnano GM, Ramenghi LA, Bellini C. Congenital chylothorax: Current evidence-based prenatal and post-natal diagnosis and management. Lymphology 2019; 52:108-125. [PMID: 31874123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Congenital chylothorax is an uncommon condition but represents the main cause of congenital pleural effusion during the neonatal period. It usually appears before birth, both as an isolated disorder or in association with hydrops fetalis, negatively affecting the subsequent neonatal outcome. Prenatal treatment is usually considered to ensure a satisfactory lung development in case of moderate to severe pleural effusion or in the presence of hydrops, although consensus on treatment timing and modalities has not been reached to date. Both medical and surgical therapeutic strategies are available to treat this condition and novel treatment options have been recently attempted with acceptable results in both prenatal and post-natal setting. The heterogeneous clinical presentation of congenital chylothorax together with its rarity, its numerous etiologies and the absence of a highly effective treatment renders the diagnostic and therapeutic approach difficult to standardize. In addition, adequate visualization of the lymphatic system is complex, especially in small neonates, although new promising techniques have been developed lately and may contribute to improved management of this serious but infrequent condition. This review focuses on the current evidence base for the diagnosis and treatment options for congenital chylothorax, suggesting a rational diagnostic and therapeutic approach both in the prenatal and in the neonatal period.
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Affiliation(s)
- L C De Angelis
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - T Bellini
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - R I Kylat
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - M Bernas
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - F Boccardo
- Department of Surgery, University of Genova, Italy
| | - D Paladini
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Genova, Italy
| | - G M Magnano
- Department of Fetal Medicine & Surgery Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - L A Ramenghi
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
| | - C Bellini
- Department Mother & Child, Neonatal Intensive Care Unit, IRCCS Istituto Gaslini, Genova, Italy
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Krishna YT, Love MW, Gates RL, Webb KM. Contralateral Chylothorax after Congenital Diaphragmatic Hernia Repair. Am Surg 2018; 84:e360-e361. [PMID: 30454498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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24
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Campbell CR, Ham PB, Pipkin W, Hatley R, Walters KC. Total Parenteral Nutrition Lipid Emulsion Pleural and Pericardial Effusions May Present Similar Chylothorax with Milky White Chest Tube Output after Tracheoesophageal Fistula Repair. Am Surg 2018; 84:e357-e359. [PMID: 30269706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Lei Y, Feng Y, Zeng B, Zhang X, Chen J, Zou J, Su C, Liu Z, Luo H, Zhang S. Effect of Prophylactic Thoracic Duct Ligation in Reducing the Incidence of Postoperative Chylothorax during Esophagectomy: A Systematic Review and Meta-analysis. Thorac Cardiovasc Surg 2018; 66:370-375. [PMID: 28464192 DOI: 10.1055/s-0037-1602259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES There is no consensus on the effectiveness of prophylactic thoracic duct ligation (PLG) in esophagectomy for reducing the incidence of postoperative chylothorax. We performed a systemic review and meta-analysis to study its efficacy. METHODS A systemic review of the publications was performed on three databases to identify all the relevant literature on comparative outcomes of PLG and nonprophylactic thoracic duct ligation (NPLG). The primary end point was the incidence of postoperative chylothorax. RESULTS Seven studies with comparative data on PLG (n = 2,178) versus NPLG (n = 3,048) were identify from the current publications. Comparison showed no significant difference between PLG and NPLG on the incidence of postoperative chylothorax (relative risk = 0.431; 95% confidence interval, 0.186 to 1.002; p = 0.050). CONCLUSIONS Although some studies showed that PLG during the esophagectomy was effective to lower the incidence of postoperative chylothorax, no evidence was observed in the present meta-analysis. Further research is warranted to validate the findings.
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Affiliation(s)
- Yiyan Lei
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Yanfen Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P. R. China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Bo Zeng
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Xin Zhang
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Jingfu Chen
- Department of Oncology, The Third People's Hospital of Dongguan City, Dongguan, Guangdong, P. R. China
| | - Jianyong Zou
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Chunhua Su
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Zhenguo Liu
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Honghe Luo
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
| | - Shuishen Zhang
- Department of Thoracic Surgery, Sun Yat-sen University, the First Affiliated Hospital, Guangzhou, Guangdong, P. R. China
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Tanoue N, Moedano L, Witte M, Montague M, Lukefahr A, Bernas M. Primary versus trauma-induced Gorham-Stout disease. Lymphology 2018; 51:18-27. [PMID: 30248728 PMCID: PMC7852030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gorham-Stout disease - also known as "disappearing bone disease" is currently considered a single entity with varying clinical manifestations. We reviewed the existent literature from the earliest historic description(Jackson in 1838) and Gorham and Stout's original series of patients, multiple case reports and series since. After analyzing 212 reported cases, we identified 76 cases with details that recorded either a history of multifocal disease or an identifiable history of preceding trauma. From this review, we have defined two distinct Gorham-Stout entities - those characteristically associated with lymphangiomatosis [a form of GLA (generalized lymphangiomatosis) questionably distinguishable by bone biopsy and radiologic appearance] with multifocal distributed bone lesions, and those others, usually self-limited, first appearing after a traumatic event and always confined to a single bone or closely adjacent one. Multifocal disease is more likely to have chylothorax as a complication. These two Gorham-Stout entities differ in their demographic distribution, clinical history and manifestations, and they follow divergent clinical courses. The prognosis differs, and so should approaches to monitoring as well as acute and long-term treatment. Further research should seek to identify and define the differences in pathology and molecular mechanisms.
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Affiliation(s)
- N Tanoue
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - L Moedano
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - M Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - M Montague
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - A Lukefahr
- Department of Pahtology, University of Arizona College of Medicine, Tucson, Arizona USA
| | - M Bernas
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
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Hvass M, Fransen JL, Bruun JM. [Chylothorax]. Ugeskr Laeger 2017; 179:V05170429. [PMID: 29260693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chylothorax is a rare condition caused by obstruction or disruption of the lymphatic branches draining the lower body and gastrointestinal tract. Chylothorax is characterized by the presence of lymphatic fluid with triglycerides and chylomicrons in the pleural cavity. The diagnosis is confirmed, when the level of triglycerides is above 1.24 mmol/l (i.e. 110 mg/dl). Aetiologically, chylothorax can be divided into traumatic or non-traumatic, and this separation is of pathophysiological importance, since the treatment should be individualized aiming at the underlying cause of the condition.
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Abstract
BACKGROUND Chylothorax is a disease that has various causes such as neoplasm, infection, post-surgery trauma, congenital, and venous thrombosis. In approximately 15% of cases of chylothorax, the exact cause is unknown. We report a case of delayed occurrence of right chylothorax in a patient who had multiple segmental ribs fracture on his left side. CASE PRESENTATION A 70-year-old Asian man had a "rollover" accident in which the cultivator he was driving overturned. He presented to our hospital with the main complaint of severe dyspnea. On chest computed tomography, multiple ribs fracture from the first to the eighth rib of the left side of his chest and left-sided hemopneumothorax were presented, but there was no evidence of fracture in the right side of his chest. After closed thoracostomy, an emergency operation for open reduction of fractured ribs was performed. On the fifth postoperative day, tubal feeding was performed. On the next day, a plain chest X-ray image showed pleural effusion of the right side of his chest. After insertion of a small-bore chest tube, 3390 ml of fluid for 24 hours was drained. The body fluid analysis revealed triglycerides levels of 1000 mg/dL, which led to a diagnosis of chylothorax. Although non-oral feeding and total parenteral nutrition were sustained, drain amount was increased on the fifth day. Surgical treatment (thoracoscopic thoracic duct ligation and pleurectomy) was performed in the early phase. The right chest tube was removed on the 14th postoperative day after the effusion completely resolved and he was uneventfully discharged. CONCLUSIONS In this case, as our patient was in old age and had multiple traumas, surgical treatment for chylothorax needed to be performed in the early phase.
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Affiliation(s)
- Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 Republic of Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 Republic of Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739 Republic of Korea
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Utture A, Kodur V, Mondkar J. Chemical Pleurodesis with Oxytetracycline in Congenital Chylothorax. Indian Pediatr 2016; 53:1105-1106. [PMID: 28064267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Congenital chylothorax is an accumulation of chyle in the pleural space that may present in neonatal period with respiratory distress. CASE CHARACTERISTICS A 34-week preterm who presented with massive congenital chylothorax complicated with hydrops fetalis. OUTCOME The neonate was treated successfully by pleurodesis with Oxytetracycline. MESSAGE Pleurodesis with oxytetracycline seems to be effective in treatment of congenital chylothorax.
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Affiliation(s)
- Alpana Utture
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India. Correspondence to: Dr Alpana Utture, Associate Professor, Department of Neonatology, LTMMC and LTMGH, Mumbai, India.
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Kasdallah N, Kbaier H, Ben Salem H, Blibech S, Bouziri A, Douagi M. Povidone Iodine Pleurodesis for Refractory Congenital Chylothorax: A Review of Literature. Tunis Med 2016; 94:834. [PMID: 28994881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Povidone iodine (PVI) pleurodesis is commonly used in adult. However, this procedure is still nonconsensual in newborns. AIMS This article aimed to report a new case of refractory congenital chylothorax (CCT) managed with PVI pleurodesis with a review of previousreported cases. METHODS a systematic review of similar cases published in PubMed. Clinical patterns, therapeutic modalities and outcome variables werereported. RESULT In a full term neonate presenting refractory CCT, PVI pleurodesis was performed at day 16 of life by one intrapleural instillation of PVI4% with rapid success and no side effects. Renal function and thyroid tests stilled normal before and after instillation. The analysis of 18 casesreported in Medeline and our observation provided the following data: this procedure was successful without side effects in 11/19 cases. Severeside effects were reported in four patients with high risks before procedure. CONCLUSION PVI pleurodesis seems to be effective and inoffensive in the management of refractory CCT. It may be a good alternative tosurgery. Nevertheless, randomized studies on large neonatal population are required to precise: the risks and benefits of this procedure, thetiming and the modalities of its realization (duration of intervention, dilution and dosage of PVI) according to the patient`s field (gestational age,weight and associated morbidity).
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Bellini C, Cabano R, Bellini T, Boccardo F, Morcaldi G, Ramenghi LA. Congenital Chylothorax of the Newborn: Diagnosis and Treatment in Three Pictures. Lymphology 2016; 49:150-156. [PMID: 29906078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is general agreement regarding the evident need for an international, multicenter trial including long-term follow-up to establish the correct criteria for diagnosing and managing congenital chylothorax. In an attempt to identify these criteria, which could then be used to draft a prospective multicenter trial, we propose three flow-charts showing three algorithms that could be used to: 1) obtain a definitive diagnosis of pleural chylous effusion; 2) specifically focus on chyle leakage evolution and etiology of chylothorax; and 3) focus on the management of congenital chylothorax. The aim of the algorithms we propose is to build the basis on which a strongly needed multicenter trial might be structured.
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Kim EY, Hwang HS, Lee HY, Cho JH, Kim HK, Lee KS, Shim YM, Zo J. Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography. Medicine (Baltimore) 2016; 95:e3109. [PMID: 27015184 PMCID: PMC4998379 DOI: 10.1097/md.0000000000003109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.Ten patients (age range 42-72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems.
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Affiliation(s)
- Eun Young Kim
- From the Department of Radiology and Center for Imaging Science (EYK, HSH, HYL, KSL); Department of Thoracic and Cardiovascular Surgery (JHC, HKK, YMS, JZ), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Radiology (EYK), Ajou University School of Medicine, Suwon, Korea
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Laurencet MÉ, Kherad O, Robert J, Younossian AB. [Diagnosis, management and treatment of chylothorax]. Rev Med Suisse 2016; 12:245-249. [PMID: 26999993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chylothorax is characterized by a milky pleural effusion that results from the injury to the thoracic duct, causing leakage of chyle into the pleural space. Its diagnosis relies primarily, on the determination of triglycerides and/or the identification of chylomicrons in the pleural fluid. The most common causes are traumatic, mainly after surgery. Among non-traumatic causes, tumors are the most frequent (like lymphomas). Conservative treatment is based on pleural drainage with a low fat diet and appropriate etiological approach. In case of failure, occlusion of the thoracic lymph duct should be considered, either by a surgical approach or interventional radiology.
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Agrawal A, Madaan H, Yadav S. Rheumatoid Arthritis Complicated by Pseudochylothorax Without Pleural Thickening: A Diagnostic Challenge for Clinicians. Indian J Chest Dis Allied Sci 2016; 58:59-61. [PMID: 28394099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 60-year-old female who was known to have rheumatoid arthritis for the preceding two-and-half years presented with difficulty in breathing associated with chest pain over the right hemithorax of two months duration. She was found to have a right-sided mild to moderate pleural effusion; there was no evidence of pleural thickening. The pleural fluid was pale yellow in appearance and diagnostic work-up confirmed it to be a pseudochylous pleural effusion. The present case highlights the rare occurrence of pseudochylothorax without pleural thickening as a complication of rheumatoid arthritis.
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Abstract
Extra-hepatic manifestations have seldom been described with hepatitis A, which usually manifests as mild hepatic dysfunction. We report a 3-year-old boy presenting with 3 days of fever, vomiting, abdominal distention and scleral icterus. On examination, he had tachypnea, hepatosplenomegaly, ascites and right-sided pleural effusion. A diagnostic pleural tap yielded a milky, lymphocyte-predominant exudative aspirate, with pleural fluid triglycerides of 175 mg/dl, suggestive of chylothorax. Serology for anti-HAV IgM was positive in both blood and pleural fluid. The massive effusion causing collapse of the underlying lung was drained by tube thoracostomy, which was followed by complete resolution within 2 weeks. This is the first reported case of chylothorax associated with hepatitis A infection. This report highlights that pleural effusion associated with hepatitis A infection is usually a benign, self-limiting condition which should be considered in the differential diagnosis of pleural effusion or chylothorax in a patient with acute viral hepatitis.
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Çakır U, Kahvecioğlu D, Yıldız D, Alan S, Erdeve Ö, Atasay B, Arsan S. Report of a case of neonatal chylothorax that responded to long-term octreotide treatment, and review of the literature. Turk J Pediatr 2015; 57:195-197. [PMID: 26690606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. Morbidity of congenital chylothorax (CC) is high, and prognosis is very poor if CC is associated with hydrops fetalis. Although the optimal treatment of CC has not been determined, conservative treatment and surgical intervention are employed. However, there is still little experience with the use of octreotide therapy for this condition, and optimal duration of the treatment for response evaluation is not known. We report a newborn with CC who presented with intrauterine bilateral pleural effusion and was resistant to conservative treatments. Octreotide (6 μg/kg/h) infusion was started on the 10th postnatal day due to ongoing pleural drainage. Although the patient improved rapidly with continuous administration of octreotide, we had to continue the drug for 151 days, even subcutaneously on outpatient follow-up. To the best of our knowledge, this patient is unique in receiving octreotide treatment for such a long time, with a successful outcome and a safe profile.
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Affiliation(s)
- Ufuk Çakır
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.
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Berg J, Guiot J, Heinen V, Corhay JL, Louis R, Duysinx B. [Comparison between chylothorax and pseudochylothorax]. Rev Med Liege 2015; 70:73-77. [PMID: 26011991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report two cases of lipidic pleural effusion: an arthritis-associated pseudochylothorax and a chylous pleural effusion in a HIV seropositive patient. The incidence of lipidic pleural effusions is low, especially for pseudochylothorax. We review their clinical characteristics and management.
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Madzharov P, Kovachev E, Ivanov S, Minkov R, Dimitrova Z, Ivanova V. [CONGENITAL UNILATERAL HYDROTHORAX--A CASE REPORT]. Akush Ginekol (Sofiia) 2015; 54:41-45. [PMID: 27025108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A case of isolated unilateral congenital hydrothorax with unknown etiology, graduated abortion for medical reasons in 23 weeks. The patient was later covered by antenatal care and during the examination one foetus with the massive right-sided hydrothorax was found, (diagnosed by ultrasonography and NMR) The incidence of congenital fetal hydrothorax is estimated at approximately 1 in 15,000 pregnancies. Early ultrasound diagnosis is of paramount importance for the adequate monitoring of the pregnancy and timely proof of deviation in normal fetal development.
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Lomauri K. Congenital chylothorax in newborn with trisomy 21. Georgian Med News 2014:74-77. [PMID: 25541830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Neonatal chylothorax results from the accumulation of chyle in the pleural space and may be either congenital or an acquired condition. Congenital chylothorax is most likely due to abnormal development or obstruction of the lymphatic system. It is often associated with hydrops fetalis. It can be idiopathic or may be associated with various chromosomal anomalies including Trisomy 21, Turner syndrome, Noonan syndrome, and other genetic abnormalities. Congenital pulmonary lymphangiectasia and generalized lymphangiomatosis have also been reported to be associated with congenital chylothorax. Several case reports indicate that congenital chylothorax can recur in subsequent offspring, suggesting a possible underlying genetic etiology. It is important to identify infants with chylothorax, as there are specific issues that need to be addressed in the management of these patients. We present a case of newborn with trysomy 21 (trisomy 21 was diagnosed antenatally by amniocentesis with support of Association "Perinatology"), who developed moderate Respiratory Distress Syndrome, chest X-ray and US reveal pleural effusion on right side rapid intervention was made before deterioration, requiring intensive life-saving measures. In the neonate, chylous effusion is not a common cause of pleural effusions. It is characterized as an exudate because of the high protein and lipid content once the infant is fed. The fluid will be clear/yellow to slightly cloudy in the unfed state and will quickly become milky following feeding, as chylomicrons appear in the fluid. Lymphocytes predominate in the differential cell count of chyle. The volume of fluid output can be high, and management can be challenging. We review the common manifestations of congenital chylotoraxes and emphasize the importance of early diagnosis and intervention in preventing devastating outcomes from this condition.
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Affiliation(s)
- Kh Lomauri
- Tbilisi State Medical University, G. Zhvania Pediatric Clinic, Department of Neonatal Intensive Care Unit, Georgia
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Tan IC, Balaguru D, Rasmussen JC, Guilliod R, Bricker JT, Douglas WI, Sevick-Muraca EM. Investigational lymphatic imaging at the bedside in a pediatric postoperative chylothorax patient. Pediatr Cardiol 2014; 35:1295-300. [PMID: 24972649 PMCID: PMC4167464 DOI: 10.1007/s00246-014-0946-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
Chylothorax is a rare but serious complication in children who undergo heart surgery. Its pathogenesis is poorly understood, and invasive surgical treatments are considered only after conservative management fails. Current diagnostic imaging techniques, which could aid decision making for earlier surgical intervention, are difficult to apply. Herein, we deployed near-infrared fluorescence (NIRF) lymphatic imaging to allow the visualization of abnormal lymphatic drainage in an infant with postoperative chylothorax to guide the choice of surgical management. A 5-week-old male infant, who developed chylothoraces after undergoing Norwood surgery for hypoplastic left heart syndrome, was intradermally administered trace doses of indocyanine green in both feet and the left hand. NIRF imaging was then performed at the bedside to visualize lymphatic drainage patterns. Imaging results indicated impeded lymphatic drainage from the feet toward the trunk with no fluorescence in the chest indicating no leakage of peripheral lymph at the thoracic duct. Instead, lymph drainage occurred from the axilla directly into the pleural cavity. As a result of imaging, left pleurodesis was performed to stop the pleural effusion with the result of temporary decrease of left chest tube drainage. Although additional studies are required to understand normal and abnormal lymphatic drainage patterns in infants, we showed the potential of using NIRF lymphatic imaging at the bedside to visualize the lymphatic drainage pathway to guide therapy. Timely management of chylothorax may be improved by using NIRF imaging to understand lymphatic drainage pathways.
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Affiliation(s)
- I-Chih Tan
- Center for Molecular Imaging, Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA,
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Yin D, Li H, Wang Y, Ge W, Zhu H. [One case of bilateral chylothorax after cervical lymph node dissection in thyroid carcinoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 49:775-776. [PMID: 25487592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Poisson J, Aregui A, Darnige L, Maley K, Gisselbrecht M. Association of chylothorax and direct pleura involvement in a case of Waldenström's macroglobulinaemia. Age Ageing 2014; 43:581-3. [PMID: 24855112 DOI: 10.1093/ageing/afu061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An 82-year-old male was hospitalised for dyspnoea, hypoxaemia and general fatigue; a predominant left chylothorax was revealed. Previously, he had been diagnosed with Waldenström's macroglobulinaemia (WM). Chylothorax complications in patients with WM are rare events and only six such cases have so far been reported. The most common malignant causes of chylothorax are through mediastinal adenopathy. Direct infiltration of the pleura by tumour cells is the most likely cause with this patient, and for this reason, we believe that this case is an instructive one. Chemotherapy induced rapid and persistent improvement after 10-month follow-up.
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Affiliation(s)
- Johanne Poisson
- Geriatric, European Georges Pompidou Hospital, 20-40 rue Leblanc, 75015 Paris, France
| | - Amelie Aregui
- Geriatric, European Georges Pompidou Hospital, 20-40 rue Leblanc, 75015 Paris, France
| | - Luc Darnige
- Hematology Biology, European Georges Pompidou Hospital, 20-40 rue Leblanc, 75015 Paris, France
| | - Karin Maley
- Geriatric, European Georges Pompidou Hospital, 20-40 rue Leblanc, 75015 Paris, France
| | - Mathilde Gisselbrecht
- Geriatric, European Georges Pompidou Hospital, 20-40 rue Leblanc, 75015 Paris, France
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Liu J, Yao C, Xu B, Shen W, Zhou C, Duan X, Zhou J, An R, Wang W, Ding Z, Zhao S. [Clinical analysis of 2 cases with chylothorax due to primary lymphatic dysplasia and review of literature]. Zhonghua Er Ke Za Zhi 2014; 52:362-367. [PMID: 24969935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyze the clinical characteristics and diagnosis of 2 cases with chylothorax due to primary lymphatic dysplasia and to elevate pediatrician's recognition level for this disease. METHOD Clinical manifestations of the children were retrospectively analyzed. Primary lymphatic dysplasia was diagnosed by lymphoscintigraphy. RESULT The first patient was a male aged 2-year-7-month who presented with a history of tachypnea for 43 days, fever and sore throat for 5 days at the early stage of the illness. He had a history of external injury before his illness. Physical examination showed his left chest bulging and left side diminished breath sound. His pleural effusion showed dark red (It was divided into two layers after standing, the upper layer turned into milky white, and the lower turned into hemorrhagic liquid) . White blood cell (WBC) count was 9 000×10(6)/L, mononuclear cell was 0.9, polykaryocytes was 0.1, triglyceride was 12.37 mmol/L in the pleural effusion. Contrast-enhanced lung CT (revascularization) showed pericardial effusion and a massive left sided pleural effusion. The second patient was a male aged 9 years and 6 months, who presented with a history of cough for 24 days, intermittent fever, vomiting, abdominal pain for 19 days, and edema of lower limbs for 4 days. Physical examination showed edema in both eyelids, lower extremities and scrotum. The level of albumin was 14 g/L and the titer of Mycoplasma pneumoniae IgM was 1: 320 in the serum. His hydrothorax pleural effusion showed milk white. White blood cell (WBC) count was 74×10(6)/L, mononuclear cell was 0.78, polykaryocytes was 0.22, triglyceride was 1.01 mmol/L in the pleural effusion. Chyle test showed positive in his pleural effusion and seroperitoneum. High-resolution CT of the lung revealed bilateral interstitial and parenchymal infiltration and both sided pleural effusion. Abdominal ultrasound showed giant hypertrophy of the gastric mucosa and massive ascites. Gastroscopy showed giant hypertrophy of the gastric mucosa. Lymphoscintigraphy revealed primary lymphatic dysplasia in both children. CONCLUSION Primary lymphatic dysplasia might occur in children and result in dropsy of serous cavity (chylothorax, chylopericardium, chylous ascites). Dropsy of serous cavity showed bloody or milk white. WBC count might elevate with lymphocyte increasing mostly, triglyceride was often higher than 1.0 mmol/L in dropsy of serous cavity. Primary lymphatic dysplasia can be diagnosed by lymphoscintigraphy.
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Affiliation(s)
- Jinrong Liu
- Department of Respiratory Diseases, Beijing Children's Hospital Affiliated to Capital Medical University,Beijing 100045, China
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Gheith O, Al Otaibi T, Nampoory MRN, Attia H, Halim M, Said T, Nair P, Balaha M, Awadein W, Zakariya Z, Aboatteya H, Moideenkutty N. Bilateral chylothorax in a renal transplant recipient: case report and literature review. EXP CLIN TRANSPLANT 2014; 12:148-151. [PMID: 24702147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chylothorax is the accumulation of chyle in the pleural cavity as a result of damage to the lymphatic ducts. We treated a young man who was a kidney transplant recipient who had a prior internal jugular vein permanent catheter for hemodialysis, who developed dyspnea and hypoxemia. Chest radiography showed bilateral pleural effusion. Analysis of the white, milky, cloudy, odorless effusion fluid showed cell count > 500/μL; lymphocytes, 60%; total protein, 3.6 mg/dL; urea nitrogen, 45 mg/dL; creatinine, 90 μmol/L; triglycerides, above 2.2 mmol/L (repeatedly high); lactate dehydrogenase, 450 U/L (normal); and cultures, no growth. Magnetic resonance imaging showed thrombosis of the major neck veins, superior vena cava, and azygos vein. Treatment included pleural drains, gut rest, and dietary modification, octreotide, and warfarin. The chylothorax resolved with no relapse. In summary, chylothorax may occur in patients associated with thrombosis of major veins associated with a permanent dialysis catheter.
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Affiliation(s)
- Osama Gheith
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait
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Abstract
Presently, 6 cases of IgG4-related pleuritis have been reported. We encountered a patient who developed chylothorax due to IgG4-related disease. To our knowledge, such patients have not been reported. This patient developed right-sided chylothorax and left-sided non-chylothorax lymphocyte-predominant pleuritis. Elevated serum and pleural IgG4 concentrations and histopathological analysis of pleural biopsy confirmed the diagnosis of IgG4-related pleuritis. Left-sided pleuritis improved with corticosteroid therapy, but right-sided chylothorax persists. IgG4-related disease can be one cause of chylothorax.
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Affiliation(s)
- Eisuke Kato
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
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Arrivé L, Derhy S, El Mouhadi S, Colignon N, Menu Y, Becker C. [Chest magnetic resonance lymphography]. Rev Pneumol Clin 2013; 69:265-271. [PMID: 23597634 DOI: 10.1016/j.pneumo.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 06/02/2023]
Abstract
Lymphangio-MRI is a non-invasive technique that allows the precise imaging of thoracic lymphatic vessels without contrast-enhancing agents. This technique is still in progress, and will benefit from better knowledge of thoracic lymphatic diseases and further improvement of MRI spatial resolution.
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Affiliation(s)
- L Arrivé
- Service de radiologie, faculté de médecine Pierre-et-Marie-Curie, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Affiliation(s)
- Hugh Ip
- Department of Respiratory Medicine, NHS Foundation Trust, St Thomas' Hospital, London, UK.
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Lutz P, Strunk H, Schild HH, Sauerbruch T. Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis. World J Gastroenterol 2013; 19:1140-1142. [PMID: 23467463 PMCID: PMC3582004 DOI: 10.3748/wjg.v19.i7.1140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 02/06/2023] Open
Abstract
A pleural effusion containing chylomicrons is termed chylothorax and results from leakage of lymph fluid into the pleural cavity. We report on the case of a 59-year-old woman with severe dyspnea due to a large chylothorax. She was known to have liver cirrhosis but no ascites. There was no history of trauma, cardiac function was normal and thorough diagnostic work-up did not reveal any signs of malignancy. In summary, no other etiology of the chylothorax than portal hypertension could be found. Therapy with diuretics as well as parenteral feeding failed to relieve symptoms. After a transjugular intrahepatic portosystemic shunt (TIPS) had successfully been placed, pleural effusion decreased considerably. Eight months later, TIPS revision had to be performed because of stenosis, resulting in remission from chylothorax. This case shows that even in the absence of ascites, chylothorax might be caused by portal hypertension and that TIPS can be an effective treatment option.
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Puvabanditsin S, Memon N, Lambert G, Cross G, El-Khawam R, Botti C, Balbin J. Partial trisomy 3p24.3 and partial monosomy 5p15.33: case report and a literature review. Genet Couns 2013; 24:13-20. [PMID: 23610861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report on a preterm neonate with a deletion of the distal short arm of chromosome 5p15.33 and partial trisomy of the distal short arm of chromosome 3p24.3. The patient was the first-born monozygotic twin. There were no pertinent facial or physical features except a small lower lip hemangioma. The neonate presented with cardiac defects, which included a patent ductus arteriosus, an atrial septal defect and ventricular septal defects. After 94 days of age, however, the patient died from superior vena cava syndrome, recurrent chylothoraces and generalized anasarca. Array comparative genomic hybridization (aCGH) using a custom oligonucleotide microarray (Agilent 180,000 probe platform revealed a terminal duplication of 1,128 oligonucleotide probes from 3pter to 3p24.3, spanning approximately 20.4 megabases (Mb), and a terminal deletion of 271 oligonucleotide probes from 5pter to 5p15.33, spanning approximately 4.3 Mb. This is the first report of a patient with partial trisomy 3p24.3 and partial monosomy 5p15.33 without major dysmorphic features.
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MESH Headings
- Chromosome Deletion
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 5/genetics
- Chylothorax/complications
- Chylothorax/diagnosis
- Comparative Genomic Hybridization/methods
- Diseases in Twins/diagnosis
- Diseases in Twins/genetics
- Ductus Arteriosus, Patent/complications
- Ductus Arteriosus, Patent/diagnosis
- Edema/complications
- Edema/diagnosis
- Fatal Outcome
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Ventricular/complications
- Heart Septal Defects, Ventricular/diagnosis
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Oligonucleotide Array Sequence Analysis/methods
- Superior Vena Cava Syndrome/complications
- Superior Vena Cava Syndrome/diagnosis
- Trisomy/diagnosis
- Trisomy/genetics
- Twins, Monozygotic
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Affiliation(s)
- S Puvabanditsin
- Department of Pediatrics, UMDNJ-Robert Wood Johnson, Medical School, New Brunswick, New Jersey 08903, USA.
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Richter MJ, Baumgartner R, Leuchte HH. [Chylothorax in an 87-year-old patient]. Internist (Berl) 2012; 54:105-9. [PMID: 23111591 DOI: 10.1007/s00108-012-3158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 87-year-old woman presented with a left-sided pleural effusion. The milky aspirate fulfilled the criteria of a chylothorax. Thorax computed tomography (CT) showed characteristic multiple cysts and consequently the rare diagnosis of post-menopausal pulmonary lymphangioleiomyomatosis was made. In the diagnostic work-up of pleural effusion the determination of triglycerides should be considered to confirm the diagnosis of chylothorax. In the presence of a chylothorax the differential diagnosis of lymphangioleiomyomatosis should be included even in advanced age.
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Affiliation(s)
- M J Richter
- Abteilung für Pneumologie, Medizinische Klinik II, Krankenhaus Neuwittelsbach, München, Deutschland
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