Sample records for chylothorax

  1. [Fetal chylothorax]. (United States)

    Westergaard, M; Brocks, V; Eriksen, B O; Kvist, N E


    Foetal chylothorax was diagnosed in female foetus by ultrasound scanning on account of suspected twin pregnancy at the 34th week. No other signs of hydrops foetalis were found. The chylothorax reformed rapidly following intrauterine thoracocentesis which was therefore repeated immediately before Cesarean section at the 38th week in order to facilitate the perinatal cardiopulmonary adjustment. Pulmonary maturation was found to be normal. Postnatally, marked chylous effusion in the pleural cavity continued. Conservative treatment with pleural drainage and total parenteral nutrition was attempted initially. On account of the absence of response and supervening infection, it was decided to operate after the elapse of three weeks. Pleural decortication was performed with good result.


    Institute of Scientific and Technical Information of China (English)

    李单青; 张志庸; 梁锡堂; 崔玉尚


    Objectives. To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons. Method. The treatment results of 31 cases of chylothorax in PUMC hospital from 1963 ~ 1997 were retrospectively analyzed. Results. Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by smgeiy and 6 were cured. Conclusion. Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatro-genic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chyloflm-rax of unknown cause, but combination of multiple treatment measures will be neccssmy for a successful management.


    Institute of Scientific and Technical Information of China (English)

    李单青; 张志庸; 梁锡堂; 崔玉尚


    Objectives. To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons. Method. The treatment results of 31 cases of chylothorax in PUMC hospital from 1963 ~ 1997 were retrospectively analyzed. Results. Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. Conclusion. Surgical intervention should be aggressively recorm mended for the waumatic, congenital, and iatro genic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylotho rax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.


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    Flávia Fonseca FERNANDES


    Full Text Available SUMMARY A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg. Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells. Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides. Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer, especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions.

  5. New treatment of early fetal chylothorax

    DEFF Research Database (Denmark)

    Nygaard, Ulrikka; Sundberg, Karin; Nielsen, Henriette Svarre


    OBJECTIVE: To evaluate OK-432, a preparation of Streptococcus pyogenes, in the treatment of early fetal chylothorax. METHODS: A prospective study of all fetuses (n=7) with persistent early chylothorax (gestational ages 16-21 weeks) referred to the tertiary center of fetal medicine in Denmark in 2...... effusions, lung hypoplasia, or hydrops. CONCLUSION: Persistent early chylothorax is a condition with a high mortality rate and no established treatment option. Use of OK-432 is a promising therapy for selected fetuses with persistent chylothorax early in the second trimester....

  6. Quilotórax Chylothorax

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    Marcelo Alexandre Costa Vaz


    Full Text Available O quilotórax, normalmente secundário a doenças malignas, trauma, doenças congênitas, infecções e trombose da veia cava superior, é uma causa pouco freqüente de derrame pleural. O diagnóstico e tratamento precoces são importantes no sentido de prevenir a mais temida conseqüência do quilotórax, a má nutrição e conseqüente comprometimento do estado imunológico.Chylothorax, an uncommon cause of pleural effusion, is usually secondary to malignancy, trauma, congenital diseases, infections and superior vena cava thrombosis. The early diagnosis and treatment are important to prevent the most fearful consequence of chylothorax, the malnutrition with a compromised immunological status.

  7. Bilateral chylothorax, chylopericardium and chylous ascitis

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    Anil Kashyap


    Full Text Available Non-Hodgkin′s lymphoma (NHL can commonly present as chylothorax and rarely as chylopericardium. Here we are presenting a case of a 21-years-old female with bilateral chylothorax, chylopericardium and chylous ascites all together finally diagnosed to have NHL as the etiology. To the best of our knowledge, it has been reported very infrequently.

  8. Chylothorax in dermatomyositis complicated with interstitial pneumonia. (United States)

    Isoda, Kentaro; Kiboshi, Takao; Shoda, Takeshi


    Chylothorax is a disease in which chyle leaks and accumulates in the thoracic cavity. Interstitial pneumonia and pneumomediastinum are common thoracic manifestations of dermatomyositis, but chylothorax complicated with dermatomyositis is not reported. We report a case of dermatomyositis with interstitial pneumonia complicated by chylothorax. A 77-year-old woman was diagnosed as dermatomyositis with Gottron's papules, skin ulcers, anti-MDA5 antibody and rapid progressive interstitial pneumonia. Treatment with betamethasone, tacrolimus and intravenous high-dose cyclophosphamide was initiated, and her skin symptoms and interstitial pneumonia improved once. However, right-sided chylothorax began to accumulate and gradually increase, and at the same time, her interstitial pneumonia began to exacerbate, and skin ulcers began to reappear on her fingers and auricles. Although her chylothorax improved by fasting and parenteral nutrition, she died due to further exacerbations of dermatomyositis and interstitial pneumonia in spite of steroid pulse therapy, increase in the betamethasone dosage, additional intravenous high-dose cyclophosphamide and plasma pheresis. An autopsy showed no lesions such as malignant tumors in the thoracic cavity. This is the first report of chylothorax complicated by dermatomyositis with interstitial pneumonia.

  9. IgG4-related pleuritis with chylothorax. (United States)

    Kato, Eisuke; Takayanagi, Noboru; Ishiguro, Takashi; Kagiyama, Naho; Shimizu, Yoshihiko; Sugita, Yutaka


    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.

  10. [Nontraumatic chylopericardium and chylothorax in premature neonates]. (United States)

    Avrel'kina, E A; Ignat'eva, E N; Fediarova, M A; Pliukhin, S V


    Deaths of extremely premature babies undiagnosed as having spontaneous chylopericardium (CP) and chylothorax (CT) are analyzed. The specific features of these death cases are the polyetiology of CP/CT and the similarity of their pathogenesis in the absence of specific clinical symptomatology.

  11. Congenital chylothorax in newborn with trisomy 21. (United States)

    Lomauri, Kh


    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.

  12. Octreotide for the treatment of chylothorax in neonates.

    LENUS (Irish Health Repository)

    Das, Animitra


    BACKGROUND: Routine care for chylothorax in neonate includes either conservative or surgical approaches. Octreotide, a somatostatin analogue, has been used for the management of patients with refractory chylothorax not responding to conservative management. OBJECTIVES: To assess the efficacy and safety of octreotide in the treatment of chylothorax in neonates. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (to March 7, 2010). We assessed the reference lists of identified trials and abstracts from the annual meetings of the Pediatric Academic Societies published in Pediatric Research (2002 to 2009) without language restrictions. SELECTION CRITERIA: We planned to include randomised or quasi-randomised controlled trials of octreotide in the treatment of congenital or acquired chylothorax in term or preterm neonates, with any dose, duration or route of administration. DATA COLLECTION AND ANALYSIS: Data on primary (amount of fluid drainage, respiratory support, mortality) and secondary outcomes (side effects) were planned to be collected and analysed using mean difference, relative risk and risk difference with 95% confidence intervals. MAIN RESULTS: No randomised controlled trials were identified. Nineteen case reports of 20 neonates with chylothorax in whom octreotide was used either subcutaneously or intravenously were identified. Fourteen case reports described successful use (resolution of chylothorax), four reported failure (no resolution) and one reported equivocal results following use of octreotide. The timing of initiation, dose, duration and frequency of doses varied markedly. Gastrointestinal intolerance and clinical presentations suggestive of necrotizing enterocolitis and transient hypothyroidism were reported as side effects. AUTHORS\\' CONCLUSIONS: No practice recommendation can be made based on the evidence identified in this review. A prospective registry of

  13. Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature



    Background: Chylothorax is a rare complication of gastric adenocarcinoma and data on its identification, prevalence and outcomes are scant. Objectives: To enable identification of gastric carcinoma as a cause of chylothorax. Methods: A case report and a systematic review were conducted of all reported cases of gastric adenocarcinoma with chylothorax as the presenting complaint in the English literature. Results: Chylothorax is a rare presenting complaint of gastric adenocarcinoma. There are o...

  14. Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

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    Pêgo-Fernandes Paulo M.


    Full Text Available In children, chylothorax occurs mainly after cardiac and thoracic surgeries. One of the recommended postsurgery treatments is ligation of the thoracic tract, when all other conservative treatments have failed. We report 4 cases of chylothorax in patients who were successfully treated with this approach, which resulted in a decrease in pleural drainage without recurrent chylothorax.

  15. Octreotide for the Management of Chylothorax in newborns, case report

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    Reza Saeidi


    Full Text Available Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.

  16. Bilateral spontaneous chylothorax after severe vomiting in children (United States)

    Rodrigues, Antonio Lucas Lima; Romaneli, Mariana Tresoldi das Neves; Ramos, Celso Dario; Fraga, Andrea de Melo Alexandre; Pereira, Ricardo Mendes; Appenzeller, Simone; Marini, Roberto; Tresoldi, Antonia Teresinha


    Abstract Objective: To report the case of a child with bilateral chylothorax due to infrequent etiology: thoracic duct injury after severe vomiting. Case description: Girl, 7 years old, with chronic facial swelling started after hyperemesis. During examination, she also presented with bilateral pleural effusion, with chylous fluid obtained during thoracentesis. After extensive clinical, laboratory, and radiological investigation of the chylothorax etiology, it was found to be secondary to thoracic duct injury by the increased intrathoracic pressure caused by the initial manifestation of vomiting, supported by lymphoscintigraphy findings. Comments: Except for the neonatal period, chylothorax is an infrequent finding of pleural effusion in children. There are various causes, including trauma, malignancy, infection, and inflammatory diseases; however, the etiology described in this study is poorly reported in the literature. PMID:27178371

  17. Noonan syndrome and chylothorax; Sindrome de Noonan y quilotorax

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    Martinez-Leon, M. I.; Ceres-Ruiz, L.; Solbes-Vila, R.; Valls-Moreno, E. [Hospital Infantil del C.H.U. Carlos Haya. Malaga (Spain)


    Chylothorax during childhood usually develops as a result of posto-perative complications following cardiothoracic surgery. It is rarely due to the malformations of the lymphatic system associated with dysmorphic syndrome. We report two cases of Noonan syndrome involving neonatal development of chylothorax. In children with the Noonan phenotype who develop pleural effusion during the neonatal period in the absence of obstetric trauma, it is advisable to rule out the presence of congenital lymphatic malformation and study the pleural effusion, initially introducing conservative treatment with dietary therapy. Chest radiography, ultrasound and computed tomography reveal the presence of the pleural effusion and parenchymal pattern compatible with chloroethoxy and lymphangiectasis. (Author) 15 refs.

  18. [Waldenström macroglobulinemia complicated with chylothorax]. (United States)

    Misaki, Sayaka; Sakoda, Hiroto; Hakata, Saya; Shigematsu, Michio; Hoshida, Yoshihiko


    An 81-year-old male had been diagnosed with Waldenström macroglobulinemia (WM) eight years previously and had thus been administered appropriate treatment. Left chylothorax later developed at 3 years and 8 months after the initial diagnosis. He was hospitalized with severe anemia, general fatigue, and appetite loss one year prior to this presentation and died due to a severe fungal infection. Autopsy revealed the presence of 1,300 ml chylothorax and infiltration of lymphoplasmacytic lymphoma (LPL) cells throughout his entire body. LPL cells were found to have invaded the excitation conducting system in the heart. In an evaluation of a resected lung tissue specimen of pneumothorax, subpleural infiltrated lymphoid cells were observed to show immunohistochemical positivity for IgM and bcl-2. Although these lymphoid cells were initially considered to be non-neoplastic lymphocytes, they were later determined to be LPL cells, which thus induced dilatation and proliferation of the lymph vessels. Chylothorax complications in patients with WM are rare events and only six such cases have so far been reported. The present case is considered to be an instructive one in which autopsy suggested the invasion of LPL cells to be involved in the development of arrhythmia, pneumothorax, and chylothorax before death.

  19. The use of octreotide to treat congenital chylothorax. (United States)

    Paget-Brown, Alix; Kattwinkel, John; Rodgers, Bradley M; Michalsky, Marc P


    We report the use of the octreotide (a somatostatin analogue) in the treatment of idiopathic congenital chylothorax in a patient with Turner's syndrome who had previously failed conservative medical therapy. The patient improved rapidly after initiation of octreotide with complete resolution after 5 days of continuous therapy (10 microg/kg per hour).

  20. Chylothorax--a conservative approach (a case report.

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    Oak S


    Full Text Available Lymphatic blockage due to a non-specific inflammation probably of a filarial origin caused dilatation and ectasia of lymph channels at thoracic inlet of a child. Transudation of lymph through these channels led to chylothorax. The present case report highlights the significance of conservative approach towards this complex problem.

  1. Dasatinib-induced chylothorax in chronic myeloid leukemia (United States)

    Abbas, Shabber Agha; Bhatti, Hammad; Braver, Yvonne; Ali, Sayed K.


    Pulmonary adverse events are common abnormalities associated with the use of dasatinib in chronic myeloid leukemia. We present a case of a 69-year-old man who suddenly developed a rare chylothorax pulmonary adverse event following 10 months of dasatinib treatment.

  2. Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature

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    Uma Devaraj


    Full Text Available Background: Chylothorax is a rare complication of gastric adenocarcinoma and data on its identification, prevalence and outcomes are scant. Objectives: To enable identification of gastric carcinoma as a cause of chylothorax. Methods: A case report and a systematic review were conducted of all reported cases of gastric adenocarcinoma with chylothorax as the presenting complaint in the English literature. Results: Chylothorax is a rare presenting complaint of gastric adenocarcinoma. There are only 18 case reports in the world literature, of which six are in English. Chylothorax occurred variably in gastric adenocarcinoma, either as a presenting feature or as a complication of therapy. Here, we analyze the index case and six patients in whom gastric carcinoma presented with chylothorax as the initial symptom. Respiratory features of cough and dyspnea preempted any abdominal complaint. Bilateral chylothorax (66% with associated chylous ascites (50% was common. Four of the six patients had skin lymphedema also as a prominent feature. The chylothoraces have been treated by therapeutic pleurocentesis, intercoastal tube drainage and restriction of oral intake. Gastric adenocarcinoma was associated with high mortality (50% and morbidity. Conclusions: Chylothorax can be the presenting feature of gastric adenocarcinoma. A thorough search for this life-threatening disease should be done before labeling the chylothorax as idiopathic.

  3. Incidence and Etiology of Chylothorax after Congenital Heart Surgery in Children

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    Parvin Akbari-Asbagh


    Full Text Available Background: Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease (CHD surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax.Methods: We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid (except when the patients were fasting in the immediate postoperative period, a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous.Results: Over a 37-month period, 435 (mean age = 51.6 months; 232 males patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax;3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and  2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax (p value < 0.0001.Conclusion: Our study showed a significant association between the Fontan surgery and chylothorax.

  4. Rapid decline of follicular lymphoma-associated chylothorax after low dose radiotherapy to retroperitoneal lymphoma localization

    NARCIS (Netherlands)

    Van De Voorde, Lien; Vanneste, Ben; Borger, Jacques; Troost, Esther G C; Werner, Philo


    Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases w

  5. Development of bilateral chylothorax in a younger female secondary to tuberculosis

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    Surya Kant


    Full Text Available Chylothorax is a rare clinical entity characterized by a milky white aspirate with increased triglyceride levels. The commonest etiology is malignancy and trauma, and bilateral chylothorax, secondary to tuberculosis, is an extremely rare cause, as observed in the present case.

  6. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

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    Lyon, Stuart, E-mail:; Mott, Nigel, E-mail:; Koukounaras, Jim; Shoobridge, Jen [Alfred Hospital, Department of Radiology (Australia); Hudson, Patricio Vargas [Clinica Alemana, Department of Radiology (Chile)


    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  7. VATS therapy of chylothorax caused by leiomyomatosis complicated with tuberous sclerosis complex

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    Adrienn Csiszkó


    Full Text Available Lymphangioleiomyomatosis with tuberous sclerosis complex is a rare disease. One of the most frequent complications of lymphangioleiomyomatosis is pleural effusion (chylothorax wich can be treated with the use of VATS. Authors report a case of pulmonary lymphangioleiomyomatosis in a 56-year-old female patient with tuberous sclerosis complex with an 8-week history of recurrent chylothorax, dyspnea and debilitating weakness. By CT scan a flat tissue proliferation was seen in the site of the thoracic duct and it was supposed to be the reason for the pleural effusion. A VATS resection of this laesion and ligation of the thoracic duct was performed successfully. Chylothorax is often associated with pulmonary lymphangioleiomyomatosis. Lymphangioleiomyomatosis combined with tuberous sclerosis complex is extremely rare. In case of chylothorax VATS treatment is successful and may be the first choice.

  8. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). (United States)

    Brissaud, O; Desfrere, L; Mohsen, R; Fayon, M; Demarquez, J L


    Chylothorax is defined as an accumulation of chyle in the pleural space. This condition usually occurs after an operation, the congenital idiopathic form being rare (1/15000 births). Recovery is observed within four to six weeks of diagnosis in most cases. Treatment is either conservative or surgical. Four cases are reported of congenital chylothorax (three idiopathic, one accompanied by diffuse lymphangectasia) managed by chemical pleurodesis (intrapleural injection of povidone-iodine). Tolerance was satisfactory: unaltered thyroid function in the three cases explored; one case of transient generalised oedema. Treatment was deemed successful in three of the four cases. One child died from renal failure (unrelated to the chemical pleurodesis). Pleurodesis by povidone-iodine appears to be well tolerated and may represent a good alternative to mechanical abrasion or surgery for congenital idiopathic chylothorax. Its use for refractory chylothorax may also decrease the morbidity related to prolonged hospital stay.

  9. Treatment Strategy for Chylothorax after Resection for Lung Cancer-16 Case Report

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    Hongjing Jiang; Changli Wang; Zhenqing Zhao; Xiaolin Li; Daliang Qi; Liqun Gong


    OBJECTIVE To review the experience of iatrogenic chylothorax after pulmcnary resections for lung cancer and to evaluate our treatment strategy. METHODS From July 1997 through December 2003, a total of 1,546 patients underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for lung cancer in our division. Sixteen patients had a postoperative chylothorax complication. All of these patients in this study were conservatively treated (closed drainage) with complete oral intake cessation and total parenteral nutrition.RESULTS All patients had their condition cured with conservative treatment. The duration of the treatment was 6-21 days. The patients were given normal diet for a mean of 9.8 days after chylothorax diagnosis.CONCLUSION If the correct treatment strategy is selected, most cases of chylothorax after pulmonary resection with systematic mediastinal lymph node dissection can be cured with a conservative strategy.

  10. A case of chylothorax treated curatively with Sapylin, a streptococcus preparation

    Institute of Scientific and Technical Information of China (English)


    Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative management, including repeated thoracentesis or pleurodesis, seems to be suitable to most cases. Herein, we present a case of efficacious pleurodesis by intrapleural injection of Sapylin, a streptococcus preparation, for the treatment of chylothorax. A 52-year-old non-smoking female farmer was diagnosed as idiopathic chylothorax after we ruled out possible causes including chest trauma,lymphoma, lung cancer, filariasis, tuberculosis, and etc. Two-time intra-thoracic injection of 3 Klinische Einheit (KE) Sapylin achieved rapid and effective control of chylothorax with no severe side effects. Sapylin may facilitate pleurodesis by producing a strong inflammatory response.

  11. A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication

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    Bikash Bhattarai


    Full Text Available Obstruction of the thoracic duct may lead to accumulation of a lymphatic fluid rich in triglycerides named chyle. When chyle accumulates in the pleural cavity, it becomes a chylothorax. Malignancy, particularly lymphoma, is the most common cause of chylothorax; however, any pathology leading to obstruction or destruction of the thoracic duct can lead to a chylothorax. This particular case investigates an incidence of chylothorax in sarcoidosis. A 54-year-old African American woman with a medical history of sarcoidosis, congestive heart failure, and smoking presented to the emergency department with complaints of bilateral foot swelling and exertional shortness of breath 3 days in duration. Physical examination was positive for bilateral crepitations with decreased air entry, abdominal ascites, and bilateral 2+ pitting edema. Both chest X-ray and chest CT were positive for stable bilateral pleural effusions (when compared to imaging done 3 years previously, and thoracocentesis and paracentesis were positive for chylous fluid accumulation. Chylothorax was diagnosed, and based on the previous medical history, the lymphadenopathy of sarcoidosis was determined to cause the occlusion of the thoracic duct. Lymphoscintigraphy and surgical intervention were advised; however, the family decided on conservative management and the patient expired intubated in the ICU. Chylothorax is a rare manifestation of sarcoidosis and high index of suspicion should be there to diagnose this, as there is high morbidity and mortality associated with it.

  12. Rapid Decline of Follicular Lymphoma-Associated Chylothorax after Low Dose Radiotherapy to Retroperitoneal Lymphoma Localization

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    Lien Van De Voorde


    Full Text Available Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases with nontraumatic malignant aetiology. Although patients usually have advanced lymphoma, supradiaphragmatic disease is not always present. We discuss the case of a 63-year-old woman presenting with progressive respiratory symptoms due to chylothorax. She was diagnosed with a stage IIE retroperitoneal grade 1 follicular lymphoma extending from the coeliac trunk towards the pelvic inlet. Despite thoracocentesis and medium-chain triglycerides (MCT, diet chylothorax reoccurred. After low dose radiotherapy (2×2 Gy to the abdominal lymphoma there was a marked decrease in lymphadenopathy at the coeliac trunk and a complete regression of the pleural fluid. In this case, radiotherapy was shown to be an effective nontoxic treatment option for lymphoma-associated chylothorax with long-term remission of pleural effusion.

  13. Chylothorax in Henoch-Schonlein purpura: a case report and review of the literature. (United States)

    Cogar, Bryan D; Groshong, Ted D; Turpin, Brian K; Guajardo, Jesus R


    Henoch-Schonlein purpura (HSP) is the most common acute vasculitis in the pediatric population, with an incidence of 10-14 per 100,000. The classic presentation of this disorder includes erythematous papules followed by palpable purpura in the lower extremities, trunk, and face, arthralgia or arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. While renal abnormalities in HSP are common, the classic pulmonary manifestations, such as hemorrhage and pneumonitis, are thought to be infrequent. Subclinical pulmonary manifestations, including diffusion defects and radiographic anomalies, seem to be quite frequent in patients with HSP but are not commonly reported. Other respiratory manifestations include pleural effusion and chylothorax, but these are rarely mentioned in the literature. Chylothorax was only reported once in an adult patient with HSP in whom the mechanism of formation was demonstrated to be secondary to transdiaphragmatic passage of chylous fluid from the peritoneal cavity. Here we describe an 8-year-old girl with HSP, nephrotic syndrome, and chylothorax, and we report the results of a review of the literature regarding respiratory complications in HSP. The present case is the first pediatric patient reported with HSP and chylothorax. The therapeutic measures utilized were effective in resolving her edema, ascites, and chylothorax, and we advocate the use of these measures as first-line therapy in future patients with similar complications from HSP.

  14. Boerhaave Syndrome, Pneumothorax, and Chylothorax in a Critically Ill Patient with Tuberous Sclerosis Complex (United States)

    Ijaz, Mohsin; Rafiq, Arsalan; Venkatram, Sindhaghatta; Diaz-Fuentes, Gilda


    Tuberous sclerosis complex (TSC) is an autosomal dominant, variably expressed multisystem disease. The predominant pulmonary features of TSC are identical to those of lymphangioleiomyomatosis (LAM). Pneumothorax, multifocal micronodular pneumocyte hyperplasia, and chylothorax are rare complications of TSC. We report a young male with pneumothorax, lung nodules, and chylous effusion who developed empyema thoracis after esophageal rupture. Hospital course was complicated by respiratory failure. Family opted to transfer to hospice care. Chylothorax is a rare complication of TSC with few scattered reports mostly in female patients. Patients with TSC are usually managed by multispecialists and it is important to be aware of the rare pulmonary manifestations of this disease. A male patient with TSC having lung nodules presenting with chylothorax and empyema thoracis from Boerhaave syndrome makes our case unique. PMID:26550497

  15. Spontaneous chylothorax complicating small cell lung cancer – Review of aetiology and diagnosis

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    S. Hanina


    Full Text Available We report the first case of spontaneous chylothorax complicating small cell lung cancer. A 52 year old female presented with exertional dyspnoea, left-sided chest and neck pain, and dysphagia. The chest X-ray on admission revealed a large left-sided pleural effusion. A subsequent CT chest showed a large anterior mediastinal mass with a left brachiocephalic and jugular vein thrombosis. The patient underwent medical thoracoscopy with chest drain insertion, which drained pleural fluid high in triglycerides, consistent with a chylothorax. Due to its uncommon nature, the management of chylothorax is not well defined. Alongside the case report, we provide a review of aetiology, mechanism and diagnosis with a brief summary of treatment options.

  16. Successful management of bilateral refractory chylothorax after double lung transplantation for lymphangioleiomyomatosis

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    Mohammed Hussein


    Full Text Available Lymphangioleiomyomatosis (LAM is a rare disease that leads to airways and lymphatic channels obstruction due to abnormal smooth muscle proliferation. It presents with dyspnea, pneumothorax or chylothorax. Lung transplantation (LT has emerged as a valuable therapeutic option with limited reports. We report a case of LAM that underwent double LT and complicated by refractory bilateral chylothorax which was managed successfully by povidone-iodine pleurodesis and the addition of sirolimus to the post-transplantation immunosuppressive therapy. The patient has no recurrence with 24 months follow-up.

  17. Complete remission of a lymphoma-associated chylothorax by radiotherapy of the celiac trunk and thoracic duct

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    Gerstein, J.; Fruehauf, J.; Bremer, M. [Dept. of Radiation Oncology, Hannover Medical School (Germany); Kofahl-Krause, D. [Dept. of Hematology, Hemostasis, Stem Cell Transplantation and Oncology, Hannover Medical School (Germany)


    Background: a chylothorax is a rare complication of mostly advanced malignant lymphomas. A case of a refractory chylothorax unresponsive to chemotherapy and successfully treated with radiotherapy is reported. Case report: a 45-year-old woman with recurrent stage IV low-grade follicular non-Hodgkin's lymphoma and a progressive chylothorax is described. The CT scans showed bulky lymphadenopathy at the thoracic trunk but no detectable enlargement of mediastinal lymph nodes. After ineffective pretreatment including chemotherapy and chest drainage, fractionated radiotherapy to the celiac trunk (20.4 Gy) and the thoracic duct (15 Gy) was performed. Result: already after 7.5 Gy a rapid decline of chylothorax was noted and the chest drain could be removed. A complete remission of the chylothorax could be achieved after 20.4 Gy. During a follow-up of 16 months no recurrence of chylothorax occurred. CT scans showed nearly complete remission of the lymphadenopathy of the celiac trunk 12 months after radiotherapy. Conclusion: radiotherapy with limited total doses is an effective treatment option for lymphoma-associated chylothorax and should always be taken into consideration, especially in cases unresponsive to chemotherapy. (orig.)

  18. Pregnancy Complicated by Gorham–Stout Disease and Refractory Chylothorax (United States)

    Hellyer, Jessica; Oliver-Allen, Hunter; Shafiq, Majid; Tolani, Alisha; Druzin, Maurice; Jeng, Michael; Rockson, Stanley; Lowsky, Robert


    Introduction Gorham–Stout Disease (GSD) is a rare disorder of bony destruction due to lymphangiomatosis, and is often triggered by hormones. One complication of GSD is the development of chylothorax, which carries a high mortality rate. Very little experience has been published to guide management in GSD during pregnancy to optimize both fetal and maternal health. Case Study A 20-year-old woman with known GSD presented with shortness of breath at 18 weeks of pregnancy, due to bilateral chylothoraces which required daily drainage. To minimize chylous fluid formation, she was placed on bowel rest with total parenteral nutrition (limiting lipid intake) and received octreotide to decrease splanchnic blood flow and chylous fluid drainage. Treatment options were limited due to her pregnancy. Twice daily home chest tube drainage of a single lung cavity, total parenteral nutrition, octreotide, and albumin infusions allowed successful delivery of a healthy 37 weeks' gestation infant by cesarean delivery. Discussion This case illustrates the management of a rare clinical disease of bone resorption and lymphangiomatosis complicated by bilateral, refractory chylothoraces, triggered by pregnancy, in whom treatment options are limited, and the need for a multidisciplinary health care team to ensure successful maternal and fetal outcomes.

  19. Chylous ascites associated with chylothorax; a rare sequela of penetrating abdominal trauma: a case report

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    Plummer Joseph M


    Full Text Available Abstract We present the case of a patient with the rare combination of chylous ascites and chylothorax resulting from penetrating abdominal injury. This patient was successfully managed with total parenteral nutrition. This case report is used to highlight the clinical features and management options of this uncommon but challenging clinical problem.

  20. Bilateral chylothorax in a patient with chronic central vein thrombosis and chronic thromboembolic pulmonary hypertension

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    Avdhesh Bansal


    Full Text Available The chylothorax is not a common presentation, and bilateral chylothorax in patients with chronically high central venous pressure secondary to venous thrombosis is a rare in incidence. We reported a case of bilateral chylothorax in a patient of chronic deep vein thrombosis (DVT in central veins with chronic thromboembolic pulmonary hypertension who presented with 2 weeks history of increased breathlessness, bilateral chest discomfort and weakness. Work-up with chest X-ray and ultrasonography-chest showed gross left sided and mild right sided pleural effusion, thoracocentesis was consistent with chylothorax. Contrast enhanced computed tomography-chest showed multiple collateral formation of left side subclavian vein, venous Doppler showed old DVT in right and left subclavian veins and two-dimensional echocardiogram showed finding of severe pulmonary hypertension. After 24 h of fasting and conservative management, pleural drain became clear and decreased in the amount. Patient′s video assisted thoracoscopic surgery was done, and thoracic duct was ligated and cut down at diaphragmatic level and bilateral talc pleurodesis done. Patient improved clinically and radiologically.

  1. Chylous ascites and chylothorax due to constrictive pericarditis in a patient infected with HIV: a case report

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    Summachiwakij Sarawut


    Full Text Available Abstract Introduction Chylothorax and chylous ascites are uncommon and usually associated with trauma or neoplasms. To the best of our knowledge, constrictive pericarditis leading to chylothorax and chylous ascites in a person infected with HIV has never previously been described. Case presentation A 39-year-old Thai man was referred to our institute with progressive dyspnea, edema and abdominal distension. His medical history included HIV infection and pulmonary tuberculosis that was complicated by tuberculous pericarditis and cardiac tamponade. Upon further investigation, we found constrictive pericarditis, chylothorax and chylous ascites. A pericardiectomy was performed which resulted in gradual resolution of the ascites and chylous effusion. Conclusions Although constrictive pericarditis is an exceptionally rare cause of chylothorax and chylous ascites, it should nonetheless be considered in the differential diagnosis as a potentially reversible cause.

  2. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants. (United States)

    Fogg, Kristi L; DellaValle, Diane M; Buckley, Jason R; Graham, Eric M; Zyblewski, Sinai C


    Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth.

  3. Effects of tolvaptan on congestive heart failure complicated with chylothorax in a neonate. (United States)

    Sato, Nikiko; Sugiura, Tokio; Nagasaki, Rika; Suzuki, Kazutaka; Ito, Koichi; Kato, Takenori; Inukai, Sachiko; Saitoh, Shinji


    Tolvaptan is an oral vasopressin type 2 receptor antagonist that can be used for heart failure patients with hyponatremia or symptomatic congestion. Although the effects of tolvaptan in adults have been well documented, only limited information is available in children. The case of a neonate with congestive heart failure complicated with chylothorax after palliative surgery for transposition of the great arteries treated with tolvaptan is reported. Slow up-titration to 0.1 mg/kg successfully increased urine output and improved refractory congestive heart failure without hypernatremia. Subsequently, bodyweight and chylothorax decreased gradually. Moreover, the use of tolvaptan reduced the dosage of furosemide. Tolvaptan could be an alternative drug for neonates with congestive heart failure. Further large studies are needed to confirm the efficacy and identify the appropriate dose of tolvaptan in neonates.

  4. Blunt traumatic tension chylothorax: Case report and mini-review of the literature


    Idris, Kamal; Sebastian, Michael; Hefny, Ashraf F; Khan, Navidul Haq; Fikri M Abu-Zidan


    Tension chylothorax following blunt thoracic trauma is an extremely rare condition. Here we report such a case and review its management. A 31-year-old man was involved in a road traffic collision. The car rolled over and the patient was ejected from the vehicle. On arrival at the Emergency Department the patient was conscious and haemodynamically stable. Clinical examination of the chest and abdomen was normal. The patient had sustained fractures of the sixth cervical vertebra and the tenth ...

  5. Staphylococcal Scalded-Skin Syndrome Complicating Wound Infection in a Preterm Infant with Postoperative Chylothorax (United States)

    Peters, Bjoern; Hentschel, Juliane; Mau, Harald; Halle, Elke; Witte, Wolfgang; Obladen, Michael


    The course of infection in a 3-week-old premature newborn suffering from extensive dermatitis with flaccid blisters is described. Staphylococcus aureus was recovered from a local wound infection around a chest tube inserted to drain a postoperative chylothorax. The strain isolated tested positive for the eta gene for exfoliative toxin A, the causative agent of staphylococcal scalded-skin syndrome (SSSS). In this case, prematurity and loss of chylus with consecutive lymphopenia may have contributed to development of SSSS. PMID:9738069

  6. Blunt traumatic tension chylothorax: Case report and mini-review of the literature. (United States)

    Idris, Kamal; Sebastian, Michael; Hefny, Ashraf F; Khan, Navidul Haq; Abu-Zidan, Fikri M


    Tension chylothorax following blunt thoracic trauma is an extremely rare condition. Here we report such a case and review its management. A 31-year-old man was involved in a road traffic collision. The car rolled over and the patient was ejected from the vehicle. On arrival at the Emergency Department the patient was conscious and haemodynamically stable. Clinical examination of the chest and abdomen was normal. The patient had sustained fractures of the sixth cervical vertebra and the tenth thoracic vertebra, left pleural effusion, haematoma around the descending aorta and fracture of the right clavicle. The left pleural effusion continued to increase in size and caused displacement of the trachea and mediastinum to the opposite side. An intercostal chest tube was inserted on the left side on the second day. It drained 1500 mL of milky, blood-stained fluid. We confirmed the diagnosis of chylothorax by a histopathological examination of a cell block prepared from the left pleural effusion using Oil red O stain. The patient was managed conservatively with chest tube drainage and fat free diet. The chylothorax completely resolved on the eighth day after the injury. The patient was discharged home on day 16.

  7. Hepatitis A Associated with Chylothorax: An Uncommon Presentation of a Common Infection. (United States)

    Mehta, Kayur; Shinde, Supriya; Rego, Sylvan; Shet, Anita


    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.

  8. Transjugular Intrahepatic Portosystemic Shunt for Treatment of Cirrhosis-related Chylothorax and Chylous Ascites: Single-institution Retrospective Experience

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    Kikolski, Steven G., E-mail:; Aryafar, Hamed, E-mail:; Rose, Steven C., E-mail: [University of California San Diego Health Sciences, Department of Radiology (United States); Roberts, Anne C., E-mail: [University of California San Diego Health Sciences, Department of Vascular and Interventional Radiology (United States); Kinney, Thomas B., E-mail: [University of California San Diego Health Sciences, Department of Radiology (United States)


    PurposeTo investigate the efficacy and safety of the use of transjugular intrahepatic portosystemic shunt (TIPS) creation to treat cirrhosis-related chylous collections (chylothorax and chylous ascites).MethodsWe retrospectively reviewed data from four patients treated for refractory cirrhosis-related chylous collections with TIPS at our institution over an 8 year period.ResultsOne patient had chylothorax, and three patients had concomitant chylothorax and chylous ascites. There were no major complications, and the only procedure-related complications occurred in two patients who had mild, treatable hepatic encephalopathy. All patients had improvement as defined by decreased need for thoracentesis or paracentesis, with postprocedure follow-up ranging from 19 to 491 days.ConclusionTIPS is a safe procedure that is effective in the treatment of cirrhosis-related chylous collections.

  9. Rare case of massive congenital bilateral chylothorax in a hydropic fetus with true mosaicism 47,XXX/46,XX. (United States)

    Cremonini, Giorgio; Poggi, Alice; Capucci, Roberta; Vesce, Fortunato; Patella, Alfredo; Marci, Roberto


    Fetal congenital chylothorax is a rare condition that occurs sporadically or can be associated with abnormal karyotype or structural chromosomal anomalies. We report a unique case of fetal congenital bilateral chylothorax associated with mosaicism 47,XXX/46,XX. A female fetus affected by massive bilateral hydrothorax and ascites was diagnosed at 34(+1) weeks of gestation. Previous ultrasonographic exams were completely normal. Immune causes of hydrops were excluded. Elective cesarean section was performed soon after bilateral thoracocentesis. The analysis of drained pleural fluid revealed its lymphatic nature. The fetal karyotyping, performed on chorionic villi at the 11th week, had shown mosaicism 47,XXX/46,XX, later confirmed in the newborn's blood. We hypothesized that chylothorax may be part of the phenotypic spectrum of 47 XXX karyotype and we suggest an ultrasound follow-up of the fetus at closer intervals than the routine timing for this condition, even if it is not usually characterized by severe phenotypic features.

  10. Chylothorax in a patient with metastatic Kaposi sarcoma: Differential diagnostic considerations

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    Ryan Alexander, DO


    Full Text Available Kaposi sarcoma (KS is a low-grade mesenchymal tumor involving blood and lymphatic vessels. There are four types, based on clinical presentation: classic, endemic (Africana, iatrogenic (typically, involving renal allograft recipients, and AIDS-associated (epidemic. Kaposi's sarcoma-associated herpes virus infection has been linked along with other factors to the development of KS. The Kaposi's sarcoma-associated herpes virus interacts and encodes for numerous molecular proteins that play a role in the pathogenesis of KS, including latency-associated nuclear antigen, viral G protein-coupled receptor, viral FLICE inhibitory protein, and viral IL-6. KS primarily affects the skin and causes disseminated disease in a variety of organs. Involvement of visceral organs other than the lining of the alimentary tract is extremely rare. While the chylous pleural effusions of KS may resemble other pulmonary diseases (including lymphangioma, lymphangectasis, and lymphangioleiomyomatosis with chylous effusions at thoracic CT, differentiating features may allow for more prompt diagnosis and treatment. The presumptive diagnosis of AIDS-related pulmonary KS is often clinical. A tissue diagnosis is not required to establish the diagnosis of pulmonary KS. There are a variety of causes of chylothorax. The primary finding is a near-water-attenuating pleural effusion. The secondary findings of chylothorax can help differentiate the etiology.

  11. Lymphangiopathy in neurofibromatosis 1 manifesting with chylothorax, pericardial effusion, and leg edema

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    Finsterer J


    Full Text Available Josef Finsterer,1 Claudia Stollberger,2 Elisabeth Stubenberger,3 Sasan Tschakoschian4 1Krankenanstalt Rudolfstiftung, Vienna, Austria; 2Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria; 3Thoracic Surgery Department, Vienna, Austria; 4Interne Lungenabt, Vienna, Austria Background: This case report documents the affliction of the lymph vessels as a phenotypic feature of neurofibromatosis-1 (NF-1. Methodology: Routine transthoracic echocardiography, computed tomography scan of the thorax, magnetic resonance angiography of the renal arteries, and conventional digital subtraction angiography were applied. Comprehensive NF-1 mutation analysis was carried out by fluorescence in situ hybridization analysis, long-range reverse transcriptase polymerase chain reaction, and multiple-ligation probe assay. All other investigations were performed using routine, well-established techniques. Results: The subject is a 34-year-old, half-Chinese male; NF-1 was suspected at age 15 years for the first time. His medical history included preterm birth, mild facial dysmorphism, "café au lait" spots, subcutaneous and paravertebral fibromas, multifocal tachycardia, atrial fibrillation, and heart failure in early infancy. Noncalcified bone fibromas in the femur and tibia were detected at age 8 years. Surgical right leg lengthening was carried out at age 11 years. Bilateral renal artery stenosis, stenosis and aneurysm of the superior mesenteric artery, and an infrarenal aortic stenosis were detected at age 15 years. Leg edema and ectasia of the basilar artery were diagnosed at age 18 years. After an episode with an erysipela at age 34 years, he developed pericardial and pleural effusion during a 4-month period. Stenosis of the left subclavian vein at the level of thoracic duct insertion was detected. After repeated pleural punctures, pleural effusion was interpreted as chylothorax. Reduction of lymph fluid production by diet and injection of talcum into

  12. Immune reconstitution inflammatory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection: a case report

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    Chen Yen-Hsu


    Full Text Available Abstract Background Patients with human immunodeficiency virus (HIV infection are at risk for Mycobacterium tuberculosis (TB coinfection. The advent of antiretroviral therapy restores immunity in HIV-infected patients, but predisposes patients to immune reconstitution inflammatory syndrome (IRIS. Case Presentation A 25-year-old HIV-infected male presented with fever, productive cough, and body weight loss for 2 months. His CD4 cell count was 11 cells/μl and HIV-1 viral load was 315,939 copies/ml. Antituberculosis therapy was initiated after the diagnosis of pulmonary TB. One week after antituberculosis therapy, antiretroviral therapy was started. However, multiple mediastinal lymphadenopathies and chylothorax developed. Adequate drainage of the chylothorax, suspension of antiretroviral therapy, and continued antituberculosis therapy resulted in successful treatment and good outcome. Conclusions Chylothorax is a rare manifestation of TB-associated IRIS in HIV-infected patients. Careful monitoring for development of IRIS during treatment of HIV-TB coinfection is essential to minimize the associated morbidity and mortality.

  13. Manejo nutricional en esofagectom a complicada por quilotrax Nutritional management of esophagectomy complicated by chylothorax

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    Lucía Llames


    Full Text Available La nutrición perioperatoria en cirugía mayor del tracto digestivo es un pilar básico dentro de la terapéutica de estos pacientes; considerando que un elevado porcentaje presenta malnutrición en el periodo preoperatorio y que es bien conocida la correlación entre la ingesta preoperatoria inadecuada y la aparición de complicaciones. Se presenta a continuación un caso clínico de sexo femenino a quien se realizó esofagectomía, que evolucionó con quilotorax en postoperatorio; y se describe el manejo nutricional que se llevó a cabo. El quilotorax, que es una complicación poco frecuente, tiene una mortalidad no despreciable debido a que produce alteraciones nutricionales, inmunológicas y de los fluidos corporales. El tratamiento adecuado es controvertido. Los principios del tratamiento conservador son reducir el flujo de quilo, drenar la cavidad pleural, prevenir las complicaciones sépticas y aportar nutrición enteral con triglicéridos de cadena media que van directamente al sistema porta o nutrición parenteral.Perioperative nutrition in digestive tract surgery (esophagectomy is a basic pillar as regards therapeutic measures, considering a high percentage of affected patients have preoperative malnutrition and since the correlation between inadequate preoperative intake and postoperative complications is widely known. Chylothorax is an unusual complication; it has a considerable mortality rate due to nutritional, immunological and body fluids alterations. Although the appropriate treatment is controversial, traditional principles in this treatment consist in reducing chyle flow, draining the pleural cavity, preventing sepsis complications and providing enteral nutrition with medium chain triglycerides (MCT, which go directly to the portal system. Total parenteral nutrition is the option when oral/enteral nutrition has failed. In this paper, a clinical case is introduced where a woman had esophagectomy which evolved into chylothorax

  14. Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita Chylothorax after surgical treatment of right-sided thoracic outlet syndrome

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    Luiz Felipe Lopes Araujo


    Full Text Available A fístula linfática como complicação de correção de síndrome do desfiladeiro torácico é um evento muito raro. Relatamos um caso de fístula linfática à direita e apresentamos uma breve revisão do tratamento de quilotórax pós-cirúrgico.Chylothorax as a complication of the surgical treatment of thoracic outlet syndrome is a quite rare event. We report a case of right-sided chylothorax and present a brief review on the treatment of postoperative chylothorax.

  15. Salmonella Enteritidis Empyema Preceding the Diagnosis of Non-Hodgkin’s Lymphoma and Subsequent Contralateral Chylothorax Treated with Radiolabeled Rituximab

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    Syed Ali


    Full Text Available Salmonella infection is common, but pleural involvement has rarely been reported. Only seven cases of Salmonella enteritidis pleural empyema have been reported; all had an associated preexisting underlying immunosuppresion or malignancy. We report the case of an apparently healthy man who developed S. enteritidis empyema. On further follow-up and surveillance, he eventually presented with non-Hodgkin’s lymphoma and a contralateral recurrent chylothorax. The latter was successfully controlled with radiolabeled rituximab, which has never been described for the above purpose in literature before.

  16. Quilotórax bilateral masivo en postoperatorio de gastrectomía subtotal Bilateral chylothorax after gastric surgery

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    E. Medina


    Full Text Available Quilotórax es el acúmulo de linfa en la cavidad pleural por obstrucción o rotura del conducto torácico. La etiología más frecuente es la neoplásica; se relaciona también con traumatismos y iatrogénica. Se presenta el caso de una mujer de 76 años con quilotórax bilateral, predominantemente derecho, durante el postoperatorio de una gastrectomía subtotal. Debutó con clínica de insuficiencia respiratoria y la evolución fue favorable sin precisar tratamiento reparador quirúrgico.Chylothorax is a lymphatic effusion of chylous in the pleural space due to thoracic duct obstruction or injury. The most frequent aetiology is cancer; it is also related to chest trauma and iatrogenic. We describe the case of bilateral chylothorax in a 76-year-old woman, right predominant, during the post-operational phase of gastric surgery. This presented itself with respiratory insufficiency and tachycardia without initial haemodynamic compromise. It presented a favourable evolution after conservative treatment, cessation of oral intake and TPN and chest tube during 10 to 14 days.

  17. Surgical treatment of iatrogenic chylothorax%医源性乳糜胸的外科治疗

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    方震宇; 夏军; 彭涛; 罗彬; 黄杰; 康敢军; 程邦昌


    Objective To investigate the optimal, surgical indications, approaches and procedures for iatrogenic chylothorax. Methods The clinical data of 46 cases with operative chylothorax after thoracic surgery were analyzed, including 36 cases of mid-upper esophageal cancer,6 cases of lung cancer,3 cases of mediastinal tumor and 1 case of adult patent ductus arteriosus. On the 6th ~41st day after surgery, all patients were reoperated to ligature the thoracic duct trunk or suture the leakage site, 3 cases underwent a third thoracotomy. Results Forty-four patients were cured(95. 6%),the complication rate was 43. 5% , and 2 patients died(4. 4%). Forty cases were followed up for 1 ~ 3 years and there was no recurrent chylothorax. Conclusion Re-operation should be performed in cases of iatrogenic chylothorax following recent post - thoracic surgery with conservative treatment, in which 24-hour chest drainage is > 1500 ml for 3 days, with no reduction trend. The right thoracic approach iss the first choice for the surgery because it could clearly reveal the thoracic duct trunk. In very extreme cases which fail the reoperation,the lariat and thoracic aorta could be dissociated through the left thoracic approach, and the missing thoracic duct could be revealed and ligated in the area between aorta and vertebra. The optimal approaches are the ligation of thoracic duct above the diaphragm and the suture of massive tissue. Surgeons should try their best to find and suture the chyle fistula.%目的 探讨医源性乳糜胸的最佳手术时机、径路和术式.方法 分析46例胸内脏器近期手术后并发乳糜胸的临床资料,含食管中上段癌36例,肺癌6例,纵隔肿瘤3例,成人动脉导管未闭症1例.术后6~41d,经再次开胸行胸导管主干结扎或漏口缝扎;另有3例行第三次开胸手术.结果 治愈44例(95.6%),发生并发症20例,并发症率43.5%,死亡2例(4.4%).随访获40例,随访时间1~3年,均未有乳糜胸复发.结论 胸内

  18. Intestinal lymphangiectasia associated with chylothorax and multiple lower extremity arteriovenous malformation:A case report and literature review

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    Haojie Li; Daoyu Hu; Lili Liang; Yao Hu; Zhen Li


    Intestinal lymphangiectasia (IL) is an uncommon protein losing enteropathy, characterized by smal intes-tinal mucosa or serosa lymphangiectasia and intestine lymph loss. Currently, IL is a very rare disease in children or adults, with typical clinical symptoms including hypoalbuminemia, absolute lymphocyte reduc-tion, ascites, edema, etc. We report a case of an adult with intestinal lymphatic ectasia accompanied by chylothorax and multiply arteriovenous malformations of the hip and lower extremity. CT and MRI revealed difuse edema and thickening of the smal intestine, accompanied by splenomegaly and pleural efusion. Extensive nodularity of lower ileum and the ileocecal region could be seen during intestinal endoscopy. Finaly, smal intestinal lamina propria lymphangiectasis was confirmed by pathological examination. To raise awareness of the disease, here we compare our case and those previously reported, and discuss the diagnosis and management of IL.

  19. Long-term success of endovascular treatment of benign superior vena cava occlusion with chylothorax and chylopericardium

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    Veroux, Pierfrancesco; Veroux, Massimiliano; Bonanno, Maria Giovanna; Tumminelli, Maria Giuseppina [Department of Surgery and Transplantation, University Hospital, Via S. Sofia, 78, 95123 Catania (Italy); Baggio, Elda [Department of Surgery and Gastroenterological Sciences, University Hospital of Verona (Italy); Petrillo, Giuseppe [Department of Radiology, University Hospital, Via S. Sofia, 78, 95123 Catania (Italy)


    The most likely etiology of benign obstruction of the superior vena cava (SVC) include fibrosing mediastinitis and iatrogenic etiologies such as sclerosis and obstruction caused by pacemakers and central venous catheter. Percutaneous stenting of SVC has been used with success both in malignant and benign superior vena cava syndrome; however, long-term follow-up of endovascular procedures is not well known. We present a case of a patient with complete occlusion of SVC of benign etiology, presenting dramatically with bilateral chylothorax and chylopericardium with cardiac tamponade, who underwent successful vena caval revascularization with thrombolytic therapy and placement of self-expanding metallic stent. The 42-month follow-up could encourage endovascular procedures even in SVC syndrome of benign etiology. (orig.)

  20. Surgical Treatment for Traumatic Chylothorax in Children%小儿损伤性乳糜胸的外科治疗

    Institute of Scientific and Technical Information of China (English)

    范茂槐; 薛峰


    Traumatic chylothorax. is uncommon in children. It is difficult to find the site of injury on the chyliferous vessels. 5 patients with traumatic chylothorax were treated by ligation of the soft tissue en bloc(including the lymphatic tissue)anterior to the vertebral column at the level of 2cm above the aortic hiatus of the diaphram. Excellent results were obtained.%作者报告根据婴幼儿乳糜管纤细及其在解剖、分型、走行上的特点,采用主动脉裂孔上方2 cm脊柱前缘组织缝扎法治疗5例损伤性乳糜胸,获得成功.术后随访6个月~14年无复发.

  1. Quilotórax espontâneo associado a atividade física leve Spontaneous chylothorax associated with light physical activity

    Directory of Open Access Journals (Sweden)

    José Carlos Miranda Torrejais


    Full Text Available O quilotórax ocorre quando há ruptura, laceração ou obstrução do ducto torácico, com liberação de quilo no espaço pleural. Pode acontecer em malformações linfáticas congênitas, linfomas, tumores de mediastino, doenças infecciosas, procedimentos cirúrgicos, traumas automobilísticos, ou ser idiopático. Apresenta sinais clínicos de dispnéia, hipotensão, edema generalizado e cianose. O diagnóstico geralmente é feito por toracocentese e o tratamento é conservador. O quilotórax espontâneo é uma condição incomum de derrame pleural, e somente é hipótese diagnóstica após a exclusão das demais causas. Descrevemos um caso de quilotórax espontâneo associado a atividade física leve em academia de ginástica.Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct, resulting in the release of chyle into the pleural space. Chylothorax can occur in cases of congenital lymphatic malformation, lymphoma, mediastinal tumor and infectious disease, as well as during surgical procedures and after traffic accident-related trauma. It can also be idiopathic. The condition presents clinical signs of dyspnea, hypotension, generalized edema and cyanosis. The diagnosis is usually made through thoracocentesis, and the treatment is conservative. Spontaneous chylothorax is an uncommon form of pleural effusion, and its diagnosis should be hypothesized only after all other causes have been ruled out. Herein, we describe a case of spontaneous chylothorax associated with light physical activity at a fitness center.

  2. Treatment of postoperative chylothorax on congenital heart diseases in children%小儿先天性心脏病术后乳糜胸的治疗

    Institute of Scientific and Technical Information of China (English)

    郭健; 李晓峰; 刘晖; 袁锋; 柏松; 赵宇东; 郑佳; 丁楠; 李奇林


    Objective To explore the treatment of postoperative chylothorax of congenital heart disease in children in order to improve the recovery of the children.Methods From Jan.2010 to Jun.2012,18 cases were diagnosed as postoperative chylothorax among the 1 288 cases in Beijing Children's Hospital,and 15 cases were from the 1 120 cases underwent median sternotomy,and 3 cases from the 168 cases received lateral thoracotomy.For the chylothorax cases of median sternotomy,fasting for 1 week with total parenteral nutrition (TPN) was prescribed,then decreasing the amount of TNP was decreased and skim milk or median chain triglyceride (MCT) diet was given and in the following 2 days only skim milk or MCT diet was given while reexamination was to be done 1 nonth after finding the postoperative chylothorax.For the cases of lateral thoracotomy,the fasting would last 2 weeks with TPN,then followed by skim milk and MCT diet.Results The 17 cases of postoperative chylothorax including 15 cases with median sternotomy and 2 cases of lateral thoracotomy recovered through fasting and TPN method.Only 1 case of lateral thoracotomy accepted second operation with ligation of thoracic duct finally.Rechecked with chest X-ray and ultrasound,no hydrothorax and hydropericardium was detected after discharge from hospital in about 2 weeks and 3 months.Conclusions Postoperative chylothorax may develop whether median sternotomy or lateral thoracotomy of congenital heart disease was performed.Now fasting is an important and effective method in treatment of postoperative chylothorax of congenital heart disease.Adopting TPN is safe from the experience of heart center in Beijing Children's Hospital for such kind of cases.Possible thoracic duct damage still needs surgical intervention.%目的 探讨小儿先天性心脏病术后出现乳糜胸的治疗方法,促进先天性心脏病术后患儿尽早康复.方法 北京儿童医院小儿心脏中心2010年1月至2012年6月共施行1 288

  3. Soporte nutricional y tratamiento con octreótido del quilotórax Nutritional support and treatment of chylothorax with octreotide

    Directory of Open Access Journals (Sweden)

    M. Sirvent Ochando


    Full Text Available Los pacientes con quilotórax presentan un riesgo elevado de malnutrición, dado que la pérdida continuada de quilo conlleva un deterioro importante del estado nutricional. Su tratamiento, inicialmente conservador, incluye medidas dietéticas y fármacos como el octreótido que disminuyen su débito. En este trabajo se presenta el caso de un paciente con quilotórax tratado mediante drenaje pleural, nutrición parenteral y octreótido, y se revisa cuál es el soporte nutricional más adecuado, así como la eficacia y seguridad de octreótido en quilotórax. Los tipos de intervención nutricional que pueden realizarse son: dieta baja en grasas suplementada con triglicéridos de cadena media (MCT, NE exenta de grasas o con alto porcentaje de MCT y nutrición parenteral. No existe consenso sobre qué medida es la más adecuada. Encontramos pocos estudios comparativos, estando basada la bibliografía en casos o series de casos. Hay autores que consideran la nutrición parenteral de primera elección, mientras que otros recomiendan empezar con una dieta específica y limitar el uso del soporte parenteral a casos concretos. La nutrición parenteral debe cubrir las necesidades del paciente además de compensar las pérdidas proteicas y energéticas que se producen en el quilotórax. El empleo de emulsiones lipídicas no está contraindicado ya que no acceden al sistema linfático. En cuanto a la NE, las fórmulas pueden ser con bajo contenido lipídico o exentas de lípidos. No hay acuerdo respecto al momento de su inicio un vez que el drenaje quiloso va disminuyendo. Existen casos y series de casos que indican que el empleo de octreótido en quilotórax parece seguro y efectivo. No existe consenso sobre el momento de iniciar el tratamiento, la dosis más adecuada, la duración de la terapia y el momento de su suspensión.Patients with chylothorax present a high risk for malnourishment since continuous loss of chylo leads to a significant impairment

  4. Chylothorax of a very low birth weight infant and literature review%极低出生体重儿乳糜胸1例并文献复习

    Institute of Scientific and Technical Information of China (English)

    罗立倩; 郭金珍; 于西萍; 李占魁


    目的探讨新生儿乳糜胸的临床特点,诊疗方法,提高对本病的认识。方法整理分析本科自开科以来收治的第一例新生儿乳糜胸的临床表现、实验室检查、影像学检查、诊疗过程等资料,并进行相关文献学习。结果该患儿临床表现为呼吸急促、肤色发绀、心率增快,X线胸片及心脏B超提示左侧胸腔积液,胸腔穿刺积液乳糜实验阳性,经呼吸机辅助通气、禁食、胸腔穿刺术后病情好转,乳糜胸未再复发。结论新生儿乳糜胸若能及时发现,患儿可通过内科保守治疗治愈,预后良好。%ObjectiveThis study was aimed to explore the clinical characteristics and diagnosis methods of newborns with chylothorax and raise awareness of the disease.Method The clinical manifestations, laboratory tests, imaging changes, and treatment process of the first case of neonatal chylothorax in our hospital were collected and analyzed.Result The clinical manifestations were tachypnea, cyanosis and high heart rate.The chest X‐ray and echocardiography showed a left pleural effusion.The chyle test was positive. By treatment of mechanical ventilation, fasting, and thoracocentesis, the baby got better and the chylothorax did not relapse.ConclusionThe majority of cases with neonatal chylothorax can be cured with medical conservative treatments and have good prognosis if they get early diagnosis and treatment timely and effectively.

  5. 胸腔镜食管癌术前口服脂肪乳预防乳糜胸的临床研究%Oral administration of intralipid before esophagectomy by VATS for esophageal cancer prevents chylothorax

    Institute of Scientific and Technical Information of China (English)

    杨冉; 韩金利; 张卫民; 侯建彬


    Objective To explore whether preoperative oral administration of intralipid can decrease the rate of postoperative chylothorax in patients with esophageal cancer.Methods 458 patients with esophageal cancer undergoing esophagectomy by VATS (Video-Assisted Thoracoscopic Surgery) were analyzed and studied;among which,218 orally taking 250 ml intralipid 8 hours before the operation were set as an experimental group and the other 240 routinely prepared as a control group.The surgical procedure was McKeown operation by VATS or thoractomy if necessary.430 cases were failed VATS,and 28 cases were converted to open thoractomy.Thoracic duct ligation was performed for all the cases during the operation.The sex,age,location of the tumor,T stage,histologic types,surgical procedures,length of hospital stay,incidence of postoperative chylothorax,and other complications of both groups were calculated.Results There were no statistical differences in basic clinical features between these 2 groups.The incidence rate of postoperative chylothorax was lower in the experimental group than in the control group (0.92% vs.5.42%,P<0.01).2 cases of postoperative chylothorax in the experimental group were cured by conservative treatment;however,5 of the 13 cases of postoperative chylothorax in the control group were cured by conservative treatment and needed to be surgically treated,and 1 case died from lung infection and respiratory failure after the second surgery.There was no statistical difference in other postoperative complications between the 2 groups(P>0.05).Conclusions Oral administration of intralipid before esophagectomy for patients with esophageal cancer can make the thoracic duct filled with chyle,minimize the risk of iatrogenic injury,easily find the chylothorax,and lower the incidence of postoperative chylothorax.%目的 探讨食管癌患者术前口服脂肪乳能否降低术后乳糜胸发生率.方法 分析研究458例行胸腔镜手术

  6. Seat belt-induced chylothorax: a cause of idiopathic chylothorax? (United States)

    Agrawal, Vishal; Doelken, Peter; Sahn, Steven A


    Chylothoraces are associated with multiple etiologies including non-Hodgkin lymphoma and surgical trauma, representing 50% and 25% of all chylothoraces, respectively. Intrathoracic operations such as repair of coarctation of the aorta and esophagectomy are commonly associated with surgical trauma. Idiopathic chylothoraces may account for up to 15% of all chylothoraces. When a thorough evaluation finding is negative, further history to identify possible blunt, nonpenetrating trauma to the chest is warranted.

  7. Concomitancia de quilotórax y quiloascitis, caso clínico y revisión de la literatura: CASE REPORT AND REVIEW COMBINED OCURRENCE OF CHYLOTHORAX AND CHYLOUS ASCITES

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    Mónica Zagolín B


    Full Text Available Se presenta el caso de un hombre de 69 años, etílico crónico, diabético, con antecedentes de cirrosis hepática y colecistectomía. Ingresó por cuadro de ascitis y derrame pleural izquierdo masivo asociado a insuficiencia respiratoria. El estudio de ambos fluidos fue categórico para el diagnóstico de quilotórax y quiloascitis. No había antecedentes traumáticos ni de neoplasia conocida. El estudio de imágenes fue negativo para cáncer. El paciente egresó en relativas buenas condiciones luego de terapia depletiva y evacuadora parcial de ambos derrames, con franco alivio de la disnea. Se prescribió régimen oral libre de grasas. El paciente reingresó un mes después en falla respiratoria secundaria a neumonía grave sin lograr recuperarse. El informe de la autopsia reveló una lesión del conducto torácico a nivel abdominal posiblemente relacionado a la cirugía previa. La asociación de quilotórax y quiloascitis es extraordinariamente infrecuente, generalmente asociada a traumatismos, neoplasias o complicaciones postoperatorias, aunque ocasionalmente puede deberse a cirrosis hepática, insuficiencia cardíaca y síndrome nefróticoWe report a case of a 69-year-old man with a long standing history of alcohol abuse, liver cirrhosis, diabetes mellitus and previous cholecystectomy, who was admitted with respiratory failure associated with severe ascites and left pleural effusion. Both fluids analysis were diagnostic for chylothorax and chylous ascites. There was no history of trauma or cancer. The images study did not show any tumour in the thoracic or abdominal cavity. The patient was discharged in stable conditions after being treated with depletive therapy and partial evacuation of both effusions, with a remarkable improvement in respiratory function. He was on fat free oral regimen. One month later, the patient was readmitted with severe respiratory failure due to fatal acute bilateral pneumonia. The autopsy showed damage and a

  8. Atypical presentation and transabdominal treatment of chylothorax complicating esophagectomy for cancer

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    Rottoli Matteo


    Full Text Available Abstract Chylotorax is a relatively uncommon and difficult to treat complication after esophagectomy for cancer. We report a case of a young adult male who underwent neoadjuvant chemoradiationtherapy followed by Ivor-Lewis esophagectomy for a squamous-cell carcinoma of the distal esophagus. During the postoperative course the patient presented recurrent episodes of hemodynamic instability mimicking cardiac tamponade, secondary to compression of the left pulmonary vein and the left atrium by a mediastinal chylocele. Mediastinal drainage and ligation of the cisterna chyli and the thoracic duct was successfully performed through a transhiatal approach.

  9. Chylothorax in a patient with metastatic Kaposi sarcoma: Differential diagnostic considerations


    Ryan Alexander, DO; Magda Rizer, DO; William Burke, MD; Lawrence Ciment, MD


    Kaposi sarcoma (KS) is a low-grade mesenchymal tumor involving blood and lymphatic vessels. There are four types, based on clinical presentation: classic, endemic (Africana), iatrogenic (typically, involving renal allograft recipients), and AIDS-associated (epidemic). Kaposi's sarcoma-associated herpes virus infection has been linked along with other factors to the development of KS. The Kaposi's sarcoma-associated herpes virus interacts and encodes for numerous molecular proteins that play a...

  10. Soporte nutricional y tratamiento con octreótido del quilotórax Nutritional support and treatment of chylothorax with octreotide


    M. Sirvent Ochando; P. López Villodre; M. J. Martínez Seguí


    Los pacientes con quilotórax presentan un riesgo elevado de malnutrición, dado que la pérdida continuada de quilo conlleva un deterioro importante del estado nutricional. Su tratamiento, inicialmente conservador, incluye medidas dietéticas y fármacos como el octreótido que disminuyen su débito. En este trabajo se presenta el caso de un paciente con quilotórax tratado mediante drenaje pleural, nutrición parenteral y octreótido, y se revisa cuál es el soporte nutricional más adecuado, así como ...

  11. Cylothorax developing due to thrombosis in the subclavian vein: A case report


    Isik, Yasemin; Goktas, Ugur; Bınıcı, orhan; Kati, Ismail


    Chylothorax, which is a rare complication of central venous catheterization, is an accumulation of lymphatic fluid in the pleural space as a result of impairment of the integrity of ductus thoracicus. In this case report, we will look over chylothorax related to thrombus developing following subclavian vein catheterization.

  12. Spilt Milk

    Directory of Open Access Journals (Sweden)

    Sara Matani MD


    Full Text Available We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula.

  13. Cranial vena cava syndrome secondary to cryptococcal mediastinal granuloma in a cat



    The successful management of cranial vena cava syndrome with suspected secondary chylothorax due to mediastinal cryptococcal granuloma in a 4-year-old male domestic shorthair cat is described. Treatment included long-term antifungal medication, short-term corticosteroids, intermittent thoracocentesis, rutin, octreotide, and enalapril.

  14. Rare cause of paradoxical worsening of pleural effusion in a patient with tuberculosis (United States)

    Duraikannan, Paramasivan; Saheer, S; Balamugesh, T; Christopher, DJ


    A 33-year-old patient, Known case of chronic kidney disease on maintenance dialysis presented with complaints of low-grade fever and weight loss of 2 months duration. Computed tomography (CT) revealed bilateral mild pleural effusion with significant mediastinal and abdominal adenopathy. CT-guided fine-needle aspiration cytology of abdominal lymph nodes and bone marrow culture was suggestive of tuberculosis. The patient was started on four drug anti-tubercular therapy, post 6 weeks of initiation he developed new onset fever and chest X-ray revealed moderate right pleural effusion. Diagnostic thoracocentesis was suggestive of chylothorax. To the best of our knowledge, this is the first case report of chylothorax due to the paradoxical reaction in the HIV-negative tuberculous patient.

  15. Neonatal chylothorax:a case report and literature review%新生儿乳糜胸1例并文献复习

    Institute of Scientific and Technical Information of China (English)

    张慧; 贺金峰; 苏雅洁; 李龙


    Objective To report a case of neonatal chylothorax and review the related literature to help clinical diagnosis and treatment. Method The clinical data of one neonatal chylothorax child and the related literature were collected and analyzed. Result The infant was a boy whose principal clinical manifestations were cough and significant dyspnea. He was diagnosed as neonatal chylothorax by thoracentesis with the drainage of chylopleura. The treatment by antibiotics,albumin and parenteral nutrition is ineffective to him,however surgery is not an application. Conclusion The treatment of neonatal chylothorax is difficult,so the aggressive diagnosis and treatment are important.%目的:报道1例新生儿乳糜胸并复习文献,以提高对该病的认识和临床诊疗水平。方法对1例确诊为新生儿乳糜胸临床资料及治疗情况进行总结,并结合文献资料进行分析。结果患儿男孩,以咳嗽及呼吸困难为主要临床表现,行胸腔穿刺引流出乳糜样物确诊为新生儿乳糜胸,通过抗生素,白蛋白及肠外营养等支持治疗后效果欠佳,但未能进行外科治疗。结论新生儿乳糜胸治疗难度大,需积极明确诊断并治疗。

  16. Bilateral agenesis of the superior vena cava associated with congenital hydrothorax. (United States)

    Römer, S; Opgen-Rhein, B; Chaoui, R; Scheer, I; Czernik, C; Obladen, M


    Agenesis of the superior vena cava is a rare anomaly that is generally asymptomatic in the neonate. We report a male neonate with bilateral (total) agenesis of the superior vena cava with obstructed thoracic duct and subsequent congenital hydrothorax, anomalies that were detected by prenatal ultrasound at 25 weeks' gestation. The cardiac anomaly was confirmed by postnatal magnetic resonance angiography. The chylothorax disappeared with conservative therapy.

  17. Progressive melorheostosis in the peripheral and axial skeleton with associated vascular malformations: imaging findings over three decades

    Energy Technology Data Exchange (ETDEWEB)

    Kalbermatten, N.T.; Vock, P.; Anderson, S.E. [Dept. of Diagnostic Radiology, University Hospital, Bern (Switzerland); Ruefenacht, D. [Dept. of Diagnostic Radiology, University Hospital, Geneva (Switzerland)


    A 28-year old woman presented with Leri's disease (melorheostosis) and the rare combination of complex vascular malformations and lymphatic anomalies. Multifocal melorheostosis was segmental and unilateral, located in the left axial and peripheral skeleton, fifth thoracic vertebral body, fifth rib, left upper limb and lumbosacral spine (third lumbar body to first sacral segment). Sacral involvement was associated with spinal canal stenosis. Additionally the patient had multiple nevi and had suffered from left hemiplegia since birth. Lymphangiectasia of the mesentery and thorax led to chylothorax resistant to therapy for which the patient underwent a pleuropericardiectomy. Death ensued due to respiratory failure. (orig.)

  18. Lymphoscintigraphy SPECT/CT: Instrumental Navigator in Repair of Thoracic Duct Injury

    Energy Technology Data Exchange (ETDEWEB)

    Abaziz, Aini; Yusop, Syahrir M. [Universiti Kabangsaan Malaysia Medical Centre, Kuala Lumpur (Malaysia); Tahir, Mohd Fadzil Mohd; Lim, Yew Cheng [Gleneagles Intan Medical Centre, Kuala Lumpur (Malaysia); Gallowitsch, Hans-Jurgen [Nuclear Medicine and PETCT Centre, Klagenfurt (Australia)


    A 25-year-old female underwent resection of a large mediastinal tumour which was complicated by copious chylothorax, being worse on the left side. Minimally-in-vasive video-assisted thoracoscopic surgery (VATS) via a left-sided approach was performed and the severed ends of the thoracic duct were ligated. This only achieved temporary reduction of the amount of chylothorax, leading to a second attempt to repair the persistent leak. This prompted the surgeon to take a different approach from the previous two attempts. It was deemed too risky and potentially futile to further attempt to go after the leakage sites bilaterally. Hence, the surgeon performed a right thoracotomy to ligate the thoracic duct proximal to the leakage sites at the aortic hiatus. this successfully stopped the leak permanently. Planar lymphoscintigraphy lacks accurate anatomical depiction which SPECT-CT could offer. Conversely, anatomical imaging failed to locate the site of the leak. SPECT/CT Lymphoscintigraphy overcomes the limitation of either imaging alone, and has been reported to be valuable in documenting and depicting sites of injury. In this case, the SPECT-CT depiction and confirmation of bilateral leakage sites was pivotal in guiding the surgeon to take a different approach and achieve a permanent solution to the persistent chloroethoxy.

  19. Management of blunt pulmonary injury. (United States)

    Gallagher, John J


    Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.

  20. Human Milk for Ill and Medically Compromised Infants: Strategies and Ongoing Innovation. (United States)

    DiLauro, Sara; Unger, Sharon; Stone, Debbie; O'Connor, Deborah L


    The use of human milk (mother's own milk and/or donor milk) in ill or medically compromised infants frequently requires some adaptation to address medical diagnoses and/or altered nutrition requirements. This tutorial describes the nutrition and immunological benefits of breast milk as well as provides evidence for the use of donor milk when mother's own milk is unavailable. Several strategies used to modify human milk to meet the medical and nutrition needs of an ill or medically compromised infant are reviewed. These strategies include (1) the standard fortification of human milk to support adequate growth, (2) the novel concept of target fortification in preterm infants, (3) instructions on how to alter maternal diet to address cow's milk protein intolerance and/or allergy in breast milk-fed infants, and (4) the removal and modification of the fat in breast milk used in infants diagnosed with chylothorax.

  1. The Effect of Neoadjuvant Therapy on Early Complications of Esophageal Cancer Surgery

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    Mohammadtaghi Rajabi Mashhadi


    Full Text Available Introduction: Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR.   Materials and Methods: This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B. Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery.   Results: The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC and 28 patients had adenocarcinoma (ACC. There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT, or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected.   Conclusion:  The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer.

  2. Neonatal pleural effusions in a Level III Neonatal Intensive Care Unit

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    Mariana Barbosa


    Full Text Available Pleural effusions are rare in the newborn. Still, being familiar with this condition is relevant given its association with a wide range of disorders. Only two large series of cases on this matter have been published, with no solid conclusions established. The aim of this study is to determine the etiology, management and prognosis of pleural effusions in a population of high-risk neonates.The authors performed a retrospective study in the Neonatal Intensive Care Unit of "Hospital de São João", Porto (Portugal, between 1997 and 2014, of all newborns with the diagnosis of pleural effusion, chylothorax, hemothorax, empyema, fetal hydrops or leakage of total parenteral nutrition (TPN.Eighty-two newborns were included, 48 males and 34 females. Pleural effusions were congenital in 19 (23.2% newborns and acquired in 63 (76.8%. Fetal hydrops was the most frequent cause (15 cases, 78.9% of congenital effusions while postoperative after intrathoracic surgery was the most common cause (39 cases, 61.9% of acquired effusions, followed by leakage of TPN (13 cases, 20.6%. Chylothorax was the most common type of effusion (41.5% of cases. Pleural effusions after intrathoracic surgery were mainly (64.1% chylothoraces. Regarding use of octreotide for treatment of acquired chylous effusions, the comparative analysis showed no statistical differences between the group of alive newborns who received octreotide and the group who did not. Twenty-seven (32.9% newborns died; the causes of death were related to underlying diseases and not to the pleural effusion. Clinical outcome is generally good, except in hydropic neonates. Blood albumin level appears to be predictive of prognosis and further investigation on its clinical significance should be encouraged.


    Institute of Scientific and Technical Information of China (English)

    扎那顺巴雅尔; 王宇飞; 黄少君; 郭占林


    Objective:To compare the effect and prognosis of left chest single incision operation and right chest with ventral midline double incision operation on the mid-thoracic portion esophageal squamous cell cancer. Methods:The date of 88 mid-thoracic portion esophageal squamous cell cancer patients treated in the affiliated hospital of Inner Mongolia medical university during January 2008 to December 2012 were retrospectively analyzed. 45of them received left chest single incision operation (ingle incision operation group),43of them received right chest with ventral midline double incision operation ( double incision operation group ) . The number of dissected lymph node. The rate of anastomotic recurrence 、strictures. recurrent laryngeal nerve injury、 incidence of chylothorax. 3years disease-free surialval rates of the two groups were compared. Results:The number of lymph nodes resected in double incision operation group was more than in single incision operation group(26. 5±4. 3 vs 14. 7±4. 2),(P<0. 05);3years disease-free surialval was higher in double incision operation group ( P<0 . 05 );The rate of recurrent laryngeal nerve injury was higher in double incision operation group ( P<0 . 05 );The rate of anastomotic recurrence、stricturesand and the incidence of chylothorax were higher in signal incision operation group ( P<0 . 05 ) . Conclusion:Right chest with ventral midline double incision operation can increase the 3 years disease-free surialval. can reduce the anastomotic re-currence 、strictures and incidence of chylothorax in patients with mid-thoracic portion esophageal squamous cell cancer.%目的::比较右胸、上腹部切口和左胸切口手术治疗胸中段食管鳞癌的疗效及并发症。方法:选取我院自2008-1~2012-12收治的43例行左胸切口治疗(单切口组)和45例行右胸、上腹切口治疗(双切口组)病人,回顾性分析两种术式淋巴结清扫数目、吻合口复发率、术后3a无病生存率、术

  4. Lymphangioleiomyomatosis: differential diagnosis and optimal management

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    Xu KF


    Full Text Available Kai-Feng Xu,1 Bee Hong Lo2 1Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China; 2Developmental Pediatrician, PECAT, Children's Hospital Westmead, Sydney, NSW, Australia Abstract: Lymphangioleiomyomatosis (LAM is an uncommon disease presented as diffuse thin-walled cystic changes in the lung. The main differential diagnoses include pulmonary Langerhans' histiocytosis (PLCH, Birt-Hogg-Dubé syndrome (BHD, lymphoid interstitial pneumonia (LIP, and amyloidosis. A combination of clinical, radiological, and pathological approaches as well as genetic testing will clarify the diagnosis in most cases. LAM is a disease almost exclusively in women. Dyspnea, pneumothorax, and hemoptysis are common presentations in LAM patients. LAM is also a lymphatic disorder affecting lymphatic vessels and lymph nodes. Chylothorax, chylous ascites, and lymphangiomyomas are frequently seen. LAM can present sporadically as a single entity or as part of tuberous sclerosis complex (TSC. Angiomyolipoma (AML is a characteristic extra-pulmonary lesion, either found in association with sporadic or TSC-related LAM. High-risk populations should be screened for LAM, including adult women with TSC and female patients with spontaneous pneumothorax, AMLs in the kidney, and diffuse cystic lung diseases. Definitive diagnosis of LAM is based on a high level of clinical suspicion on presentation supported by pathological findings or by a distinct feature, such as a history of TSC, AMLs in the kidney, chylothorax, or chylous ascites. Vascular endothelial growth factor-D (VEGF-D in serum is a noninvasive and reliable diagnostic biomarker. In experienced centers, trans-bronchial lung biopsy (TBLB provides a convenient and safe way to obtain lung specimens for diagnostic purposes. An effective treatment for LAM is now available, namely using a mechanistic target of rapamycin (mTOR inhibitor such as sirolimus. Efficacy of sirolimus has

  5. Eosinophilic pleural or peritoneal effusions in dogs and cats: 14 cases (1986-1992). (United States)

    Fossum, T W; Wellman, M; Relford, R L; Slater, M R


    Case records of 9 dogs and 5 cats with eosinophilic effusions were reviewed. The animals ranged from 11 months to 13 years old. Seven animals had pleural effusions, 5 had peritoneal effusions, and 2 had pleural and peritoneal effusions. Neoplasia was confirmed in 6 animals and suspected in 1. Eosinophilic pleural effusion was diagnosed 2 days after pneumothorax developed as a consequence of thoracic tube placement in a cat, and pneumothorax was diagnosed in another cat with eosinophilic peritoneal effusion. Other abnormalities seen in 1 or 2 animals associated with eosinophilic effusion were radiographic signs of interstitial or peribronchial pulmonary infiltrates, a history of allergic respiratory tract and skin disease, intestinal lymphangiectasia and lung lobe torsion, chylothorax, bite wounds causing intestinal perforation, and feline leukemia virus infection. Based only on the protein concentration of the effusion, 7 effusions were classified as transudates and 7 were classified as exudates. Five of the 14 animals had eosinophilia (> 1,200 eosinophils/microliters); 3 of these animals had neoplastic disease. Mean eosinophil count in blood samples was not significantly different between animals with neoplasia and those without. Eosinophil counts in blood samples were not linearly related to counts in effusions; however, in some animals the number of eosinophils in the effusion was much higher than the eosinophil count in blood, suggesting concentration of eosinophils in the effusion.

  6. Use of sirolimus in the treatment of lymphangioleiomyomatosis: favorable responses in patients with different extrapulmonary manifestations

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    Carolina Salim Gonçalves Freitas


    Full Text Available OBJECTIVE: Lymphangioleiomyomatosis (LAM is a rare disease that is currently considered a low-grade neoplasm with metastatic potential and variable progression. Mammalian target of rapamycin (mTOR inhibitors, such as sirolimus and everolimus, have recently become a treatment option for LAM patients, especially those with extrapulmonary manifestations. The objective of the present study was to describe a case series of four patients with LAM in Brazil who showed significant improvement, particularly in their extrapulmonary manifestations, after treatment with sirolimus (at 1-4 mg/day. METHODS: We describe four cases of LAM patients with different extrapulmonary manifestations who were treated with sirolimus. RESULTS: After treatment with sirolimus for 12 months, one patient presented resolution of severe chylothorax; one had a significant reduction in renal angiomyolipoma volume; and one showed significant regression of retroperitoneal lymphangioleiomyomas and abdominal lymph node enlargement. After treatment with sirolimus for 6 months, the remaining patient had a significant reduction in the volume of a massive retroperitoneal lymphangioleiomyoma. CONCLUSIONS: Our findings confirm that mTOR inhibitors are beneficial for patients with LAM, especially those with extrapulmonary manifestations, such as renal angiomyolipoma, lymphangioleiomyomas, and chylous effusions. However, certain aspects, such as the optimal dose, duration of treatment, and long-term adverse effects, have yet to be sufficiently clarified for mTOR inhibitors to be incorporated into LAM management protocols.

  7. [Videothoracospy in thoracic trauma and penetrating injuries]. (United States)

    Lang-Lazdunski, L; Chapuis, O; Pons, F; Jancovici, R


    Videothoracoscopy represents a valid and useful approach in some patients with blunt chest trauma or penetrating thoracic injury. This technique has been validated for the treatment of clotted hemothorax or posttraumatic empyema, traumatic chylothorax, traumatic pneumothorax, in patients with hemodynamic stability. Moreover, it is probably the most reliable technique for the diagnosis of diaphragmatic injury. It is also useful for the extraction of intrathoracic projectiles and foreign bodies. This technique might be useful in hemodynamically stable patients with continued bleeding or for the exploration of patients with penetrating injury in the cardiac area, although straightforward data are lacking to confirm those indications. Thoracotomy or median sternotomy remain indicated in patients with hemodynamic instability or those that cannot tolerate lateral decubitus position or one-lung ventilation. Performing video-surgery in the trauma setting require expertise in both video-assisted thoracic surgery and chest trauma management. The contra-indications to videothoracoscopy and indications for converting the procedure to an open thoracotomy should be perfectly known by surgeons performing video-assisted thoracic surgery in the trauma setting. Conversion to thoracotomy or median sternotomy should be performed without delay whenever needed to avoid blood loss and achieve an adequate procedure.

  8. Congenital idiopathic chylopericardium-a case report and review Of the literature%先天性乳糜性心包积液1例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    李敏; 孙正芸; 于永慧; 杨波; 林霞; 汪翼


    目的 报告1例先天性乳糜性心包积液并胸腔积液新生儿的临床表现、辅助检查与治疗转归.方法 2010-07-05山东大学附属省立医院小儿重症医学科收治1例先天性原发性乳糜性心包积液并胸腔积液新生儿,回顾分析该患儿临床资料及诊疗过程,并复习国内外相关文献.结果 该患儿产前超声检查即发现胎儿大量心包积液并胸腔积液,生后无明显症状,胸部正位X线片示心影增大(心胸比值0.75),心脏超声示大量心包积液,胸部CT显示大量心包积液并左侧胸腔积液,心包穿刺抽液乳糜定性及生化检查证实积液性质为乳糜性;连续3次心包穿刺术无效后行心包闭式引流,放置导管持续性引流2d后痊愈;术后1周、1个月心脏超声检查无复发.结论 原发性特发性乳糜性心包积液是一少见病症,多数病例仅能通过心包穿刺术证实诊断,心包穿刺及心包置管引流是有效的保守治疗手段,对复发性患者需要行手术治疗.%Objective To report a newborn case of congenital idiopathic chylopericardium associated with chyiothorax about its clinical features, ancillary diagnostic tests, treatment and prognosis. Methods A newborn case diagnosed with congenital idiopathic chylopericardium associated with chylothorax was admitted to the Pediatric Intensive Care Unit of Provincial Hospital Affiliated to Shandong University. Its clinical features, treatment and follow-up data were analyzed,and a brief review of the literature was presented. Results Bulk chylopericardium associated with chylothorax was detected with ultrasonography in fetus during antepartum. The child presented no obvious symptoms after birth. Chest X-ray demonstrated enlargement of the cardiac silhouette (cardiac/chest ratio was 0.75). Echocardiography revealed pericardial effusion. Computed tomography of the chest did not reveal any lesion obstructing the thoracic duct. The chylous nature of the fluid was confirmed by

  9. Manejo nutricional e digestibilidade no quilotórax canino Nutritional therapy and digestibility in canine chylotorax

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    Juliana Toloi Jeremias


    Full Text Available O quilotórax corresponde ao acúmulo de fluido linfático em um ou em ambos os espaços pleurais, resultante do extravasamento de linfa do ducto torácico ou de uma de suas divisões principais. Este pode estar associado à ascite quilosa em pacientes com distúrbios linfáticos sistêmicos, como na linfangiectasia, em decorrência de defeitos no transporte linfático-venoso do quilo da cavidade torácica para a circulação sistêmica. A linfangiectasia intestinal é um distúrbio obstrutivo que envolve o sistema linfático do órgão e revela-se como a causa mais comum de enteropatias associadas à má absorção e perda de proteínas em cães. São apresentados no presente relato o controle clínico com o uso de dieta caseira com baixa gordura e a quantificação da função digestiva, por meio da determinação da digestibilidade do alimento, em um cão acometido por quilotórax secundário à linfangiectasia intestinal. A dieta caseira incluiu arroz, peito de frango, cenoura, carbonato de cálcio, levedura de cerveja, suplemento vitamínico e mineral e sal. O ensaio de digestibilidade foi conduzido pelo método de coleta total de fezes. A dieta caseira foi eficaz em interromper o acúmulo de efusão quilosa torácica, restabelecer as concentrações de proteína total e albumina e promover ganho de peso no paciente. Os resultados da digestibilidade demonstraram menor aproveitamento de todos os nutrientes no cão com linfangiectasia em relação ao controle sadio.Chylothorax corresponds to accumulation of lymphatic fluid in one or both pleural spaces, resulting from the leak of thoracic duct or of one of their main divisions. This can be associated to chylous ascites in patients with systemic lymphatic disturbances, as in lymphangiectasia, due to defects in the lymphatic-veined transport of chylo from thoracic cavity to systemic circulation. Intestinal lymphangiectasia is an obstructive disturbance that involves lymphatic system of

  10. 食管癌二次手术19例原因分析%Analysis of 19 cases undergoing reoperation for complications following esophagectomy

    Institute of Scientific and Technical Information of China (English)

    杨永波; 闫万璞; 熊宏超; 梁震; 戴亮; 康晓征; 杨合利; 陈克能


    Objective To investigate the cause and the management of treatment and prevention of reoperation following esophagectomy. Methods Clinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them , 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized. Results The indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis(n=1). All the 19 patients were successfully cured without perioperative deaths and further complications. Conclusions The indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.%目的:探讨食管癌行二次手术的原因及防治措施。方法回顾性分析2000年1月至2012年12月间北京大学肿瘤医院单一手术组施行的946例食管癌手术患者的临床资料,其中19例因术后严重并发症需行二次手术,总结该19例患者的临床特点及治疗经过。结果19例二次手术的患者中因术后胸腔内出血行开胸止血术4例,因膈疝行膈疝还纳、膈肌修补术4例,因乳糜胸行胸导管结扎术4例,因腹部切口裂开行切口缝合术4例,因创伤性胰腺炎行胸腹腔探查、腹腔置管引流术1例,因肠梗阻行回盲部切除、回肠造瘘术1例,因双侧喉返神经麻痹行气管切开术1例。19例二次手术患者全部治愈,无围手术期死亡和再次并发症发生。结论

  11. Pulmonary Complications due to Esophagectomy

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    Yashar Talebi


    Full Text Available Introduction: Esophageal carcinoma is the scourge of human beings. Pulmonary compli-cations in patients who have undergone operation are common (20-30% of cases and there are no suitable tools and ways to predict these complications. Methods: During a period of 10 years, from March 1998 to February 2007, 200 patients (150 male and 50 female underwent Esophagectomy due to esophageal carcinoma in thoracic surgery ward retrospectively. Complications include the length of hospitalization, mechanical ventilation, morbidity and mortality. Patients’ risk factors include age, preoperative chemo-radiotherapy, stage of the disease and preoperative spirometry condition. Results: We grouped our patients into three categories: Normal (FEV1 ≥ 80% predicted, mildly impaired (FEV1 65% to 79% predicted, more severely impaired (FEV1 < 65% predicted.Although almost all patients had radiographic pulmonary abnormalities, significant pulmonary complications occurred in 40 patients (20% which underwent Esophagectomy. Pleural effusion and atelectasia in 160 patients (80%. 24 patients needed chest-tube insertion. 20 patients (10% developed ARDS. 14 patients (7% developed chylothorax. 20 patients (10% of patients died during their postoperative hospital stay. 30 patients (15% required mechanical ventilation for greater than 48 hours. Conclusion: We reviewed a number of preoperative clinical variables to determine whether they contributed to postoperative pulmonary complications as well as other outcomes. In general, age, impaired pulmonary function especially in those patients with FEV1 less than 65% predicted was associated with prolonged hospital length of stay (LOS. In fact pulmonary complications rate after Esophagectomy are high and there was associated mortality and morbidity.

  12. Thoracotomies in children. (United States)

    Findik, Gokturk; Gezer, Suat; Sirmali, Mehmet; Turut, Hasan; Aydogdu, Koray; Tastepe, Irfan; Karaoglanoglu, Nurettin; Kaya, Sadi


    Thoracotomies in children have been less extensively studied, as the incidence of diseases necessitating thoracotomies is low in the pediatric age group. This study reviews childhood thoracic diseases, thoracotomy approaches, indications, and complications. Surgical procedures and complications of a total of 196 children below 16 years of age who underwent thoracotomy for various reasons at the Department of Thoracic Surgery, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, between January 2000 and December 2004, were reviewed in this study. Out of the 196 patients, 77 were female (39%) and 119 (61%) were male. The most commonly encountered indications for surgery were hydatid cyst (35%), bronchiectasis (25%), chronic nonspecific pleuritis (13%), chest wall deformities (10%), and mediastinal cystic formations and masses (10%). The other indications included tuberculosis (3%), aspergilloma (0.5%), fibrohyalinized cyst (0.5%), resection of trachea (0.5%), bronchogenic cyst (0.5%), inflammatory pseudo-tumor (0.5%), sequestration (1%), lipoblastoma (0.5%), and eosinophilic granuloma (1%). Out of the 196 patients, 176 underwent lateral thoracotomy and 20 patients with a chest wall deformity underwent midsternal incision. Complications were seen in 35 patients (18%): atelectasia and secretory retention (54%), wound infection (17%), hemorrhage (3%), chylothorax (3%), intrathoracic space (3%), and postoperative extended air leakage (20%). The mean hospital stay was 15 days and we did not encounter any mortality. The physiology and anatomy of the respiratory system and especially the respiratory control mechanism in pediatric patients vary from those of the adults, resulting in a more morbid course after thoracic surgery in children. Despite severe postoperative pain, posterolateral thoracotomy is the preferred approach in adults because of an advanced intrathoracic exposure and easy manipulation. On the other hand, lower pain threshold and the

  13. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center.

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    Weiqiang Liang

    Full Text Available To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery.The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression.Among the 28 patients with postoperative pleural effusion, 24 (85.7% suffered from hemothorax, 2 (7.1% from chylothorax, and 2 (7.1% from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%, on the concave side in 4 patients (14.3%, and on both sides in 4 patients (14.3%. One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old, congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery.The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325, and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old, congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion.

  14. The result of right heart bypass operation for the treatment of complex congenital heart diseases%非体外循环下右心旁路手术治疗复杂先天性心脏病

    Institute of Scientific and Technical Information of China (English)

    赵哲; 汤楚中; 李寒; 贝亚军; 张载高; 解水本; 迟海涛


    Objective To evaluate the results of right heart bypass (RHB) with Off-pump technique operation for treating complex congenital heart disease. Mothods From October 2005 to November 2010, 94 patients with complex congenital heart disease, including tricuspid atresia, single ventricle and 27 cases of ectopia cordis were included. Sixty-eight cases, underwent bidirectional Glenn shunt and 26 cases underwent total cavopulmonary connection (TCPC). Result Four patients died, and the hospital mortality rate was 4.3%, and one patient had chylothorax. Conclusion RHB is a effective way to treatcomplex congenital heart disease, but the procedure itself is difficult. 1. Step-wise operation is better. The effect of extracardiac conduit operation with windowing operation is better than TCPC. RHB with off-pump technique is a useful procedure in early stage management.%目的 总结非体外循环下右心旁路手术治疗复杂先天性心脏病的临床经验.方法 采用非体外循环右心旁路手术治疗94例复杂先天性心脏病(包括三尖瓣闭锁、单心室等,其中心脏位置异常27例),68例行双向格林术,26例行全腔静脉-肺动脉吻合术,其中3例术中改为体外循环.结果 双向格林术围手术期手术死亡2例,全腔静脉-肺动脉连接术后死亡2例,围手术期死亡率(4.3%).结论 右心旁路手术治疗复杂先天性心脏病分期手术效果好,但手术难度增加.全腔静脉-肺动脉吻合术,外管道与右心房开窗效果好.

  15. Strategy of video-assisted thoracoscopic lymph node eradication for lung cancer: a report of 264 cases

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    Bo YANG


    Full Text Available Objective To explore the method and essential procedure for lymph node eradication during video-assisted thoracoscopic lobectomy in patients with lung cancer. Methods Two hundred and sixty-four patients with lung cancer underwent thoracoscopic lobectomy and lymph node eradication from April 2007 to April 2012 in General Hospital of PLA. In 144 cases of right lung cancer, the eradicated lymph nodes included groups 2, 3, 4R, 7, 8, 9, 10 and 11. In 120 cases of left lung cancer, the eradicated lymph nodes included groups 5 to 11. The mediastinal lymph nodes were removed en bloc according to the anatomic distribution. The clinical data and pathological results of all patients were analyzed retrospectively. Results The operation was successfully completed in all the patients, the operation time was 162.4±35.8 minutes, and the blood loss was 129.3±46.3ml. Three patients suffered from postoperative chylothorax, and they recovered after conservative treatment. Two patients suffered from the complication of hoarse voice, and one of them recovered 2 months later, and another did not recover. 8.7±1.2 and 10.6±1.4 lymph nodes of N1 and N2 were removed in patients with right lung cancer, and 8.2±1.4 and 9.2±1.3 in patients with left lung cancer. According to anatomic distribution, the number of removed lymph nodes from right superior mediastinum (including groups 2, 3 and 4R was 4.2±0.9, that of left superior mediastinum (including groups 5 and 6 was 2.8±1.0, that of inferior mediastinum (including groups 8 and 9 was 2.1±0.7, and that of group 7 was 3.3±1.8. Metastasis of N1 lymph nodes was found in 64 patients (24% and that of N2 in 21 patients (8%, and in 3 of them only lymph nodes of N2 were found to have metastasis but none in N1 lymph nodes. Conclusion In video-assisted thoracoscopic lobectomy, lymph node eradication could be accomplished in patients with lung cancer. En bloc lymph node eradication according to anatomic distribution


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    G. P. Itkin


    Full Text Available Development of new methods of visualization of the lymphatic system and in the treatment of several pathologies associated with impaired lymph fl ow. The lymphatic system is an integral part of the circulation. One of the main functions of the lymphatic system is to transport residual interstitial fl uid from the tissue back to the venous system. Despite growing recognition of the role of the lymphatic system in many disease processes, the techniques for imaging and interventions on the lymphatic system have lagged behind the well-developed methods for imaging and interventions on the cardiovascular systems. This is primarily due to small size and variability in anatomy of the lymphatic vessels, and diffi culty of introducing contrast into lymphatic ducts. Due to lack of imaging and intervention options, the fl ow function of the lymphatic system was relatively ignored over the last few decades. Recently, there has been resurgence in the interest in the fl ow function of the interventions on the lymphatic system with the development of percutaneous minimally invasive techniques, such as thoracic duct embolization, to treat life threatening lymphatic leaks. Our group recently introduced two new methods of lymphatic imaging: intranodal lymphangiography and dynamic contrast MR lymphangiography. These methods have allowed further understanding of lymphatic anatomy, pathophysiology, lymphodynamics, as well as provided guidance for novel minimally invasive lymphatic interventions. Using new techniques, the group discovered the causes and then developed treatments for several fatal conditions effecting single ventricle patients including plastic bronchitis and protein loosing enteropathy. Treatment for other conditions has evolved as well including congenital lymphodysplasia, chylothorax, and chylous ascites. The study of the liver lymphatic system has been little explored despite its signifi cant relevance as exampled in ascites formation in

  17. Lesão complexa da traqueia: correção com retalho pediculado de músculo intercostal Complex tracheal lesion: correction with an intercostal muscle pedicle flap

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    Hylas Paiva da Costa Ferreira


    Full Text Available A reconstrução esofágica é uma das mais complexas cirurgias do aparelho digestivo, principalmente quando realizada por técnicas minimamente invasivas. Esse procedimento está associado a inúmeras complicações, como deiscência de anastomose, quilotórax, necrose do tubo gástrico e fistulas. Relatamos o caso de um paciente com o diagnóstico de carcinoma epidermoide no terço distal do esôfago que foi submetido à uma esofagectomia por videotoracoscopia e laparoscopia. Durante o ato operatório, houve lesão do brônquio principal esquerdo, sendo necessária a correção cirúrgica imediata da lesão. No pós-operatório, o paciente evoluiu com insuficiência respiratória aguda e grande escape aéreo pelos drenos de tórax e pela ferida operatória cervical. Foi submetido à nova intervenção cirúrgica, através da qual se observou uma grande lesão na parede membranosa da traqueia, que foi corrigida com um retalho de músculo intercostal.Esophageal reconstruction is one of the most complex types of gastrointestinal surgery, principally when it is performed using minimally invasive techniques. The procedure is associated with various complications, such as anastomotic dehiscence, chylothorax, esophageal necrosis and fistulae. We report the case of a patient diagnosed with epidermoid carcinoma in the distal third of the esophagus. The patient was submitted to esophagectomy by video-assisted thoracoscopy and laparoscopy. During the operation, the left main bronchus was injured, and this required immediate surgical correction. In the postoperative period, the patient presented with acute respiratory failure and profuse air leak through the thoracic drains and through the cervical surgical wound. The patient underwent a second surgical procedure, during which a large lesion was discovered in the membranous wall of the trachea. The lesion was corrected with an intercostal muscle pedicle flap.

  18. Linfangioleiomiomatosis pulmonar

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    Carlos Salazar-Vargas


    Full Text Available La Linfangioleiomiomatosis pulmonar es una enfermedad muy rara, que afecta sólo mujeres en edad reproductiva. Se presenta con disnea progresiva, pneumotórax a repetición y, ocasionalmente, con hemoptisis y quilotórax. El TAC de alta resolución muestra quistes pulmonares bilaterales de tamaño variable hasta bulas francas. Histológicamente, se aprecian múltiples cavidades de paredes finas, dilatación de vasos linfáticos, venas, arterias, bronquiolos y sacos alveolares, por proliferación de haces de músculo liso que comprime las estructuras antes mencionadas y que causa entonces su dilatación. El pronóstico es malo, ya que las pacientes desarrollan insuficiencia respiratoria, lo que las conduce a la muerte. La enfermedad se asocia a la ingesta de estrógenos, píldoras anticonceptivas y se exacerba con el embarazo-, por ello se ha tratado con medróxi-progesterona y tamoxifén, con estabilización de la evolución en algunos pero no en todos los casos. Eventualmente, algunas pacientes pueden necesitar transplante pulmonar. Presentamos el caso de una mujer de 38 años con tres episodios de pneumotórax espontáneo y documentación radiológica e histológica de linfangioleiomiomatosis pulmonar.Pulmonary lymphangioleiomyomatosis is an uncommon disease, that affects only women of child-bearing age. The patients present themselves with progressive dyspnea, frequent episodes of spontaneous pneumothorax and, occasionally, with hemoptysis and chylothorax. High resolution CAT sean shows bilateral lung cysts of variable size up to frank bullae. Histologically, numerous thin walied cavities are seen, and dilatation of lymphaties, veins, arteries, bronchioles and alveolar sacs with extensiva smooth muscle proliferation, which engulfs the previously mentioned structures and causes their dilatation. The patients eventually develop respiratory insufficieney and die. This disease is associated with estrogen intake, contraceptivas and becomes worse


    Institute of Scientific and Technical Information of China (English)


    Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis.Methods Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marfan syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded.Results The mean operation time was 6. 4 hours, mean instrumented vertebrae were 6. 4 segments, and mean blood loss during operation was 364 mL. The coronal Cobb angles of the thoracic curve before and after surgery were 45.5° and 15.4° respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4°to 11.8°, with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final follow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19. 0° and 20. 1°, with a 3.6° and 8. 3° loss of correction, respectively. The apical vertebral translation was improved from 32.3 mm to 10. 5 mm for the thoracic curve, and from 13. 1 mm to 8.2 mm for the lumbar curve. There were 6cases with peri-operative complications, including 1 case of thoracic effusion, 1 case of chylothorax, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve ( 1 case also with thoracolumbar kyphosis), and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery.Conclnsions Video- assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding

  20. Clinical features, epidemiology, and therapy of lymphangioleiomyomatosis

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    Taveira-DaSilva AM


    Full Text Available Angelo M Taveira-DaSilva, Joel Moss Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA Abstract: Lymphangioleiomyomatosis (LAM is a multisystem disease of women, characterized by proliferation of abnormal smooth muscle-like LAM cells, leading to the formation of lung cysts, fluid-filled cystic structures in the axial lymphatics (eg, lymphangioleiomyomas, and renal angiomyolipomas. LAM is caused by mutations of the TSC1 or TSC2 genes, which encode, respectively, hamartin and tuberin, two proteins with a major role in control of the mammalian target of rapamycin (mTOR signaling pathway. LAM occurs sporadically or in association with tuberous sclerosis complex, an autosomal-dominant syndrome characterized by widespread hamartomatous lesions. LAM may present with progressive dyspnea, recurrent pneumothorax, or chylothorax. Pulmonary function tests show reduced flow rates (forced expiratory volume in the first second and diffusion capacity. Exercise testing may reveal gas exchange abnormalities, ventilatory limitation, and hypoxemia. The severity and progression of disease may be assessed by lung histology scores, quantification of computed tomography, pulmonary function testing, 6-minute walk tests, cardiopulmonary exercise testing, and measurement of serum vascular endothelial growth factor D levels. Sirolimus and everolimus, two mTOR inhibitors, are effective in stabilizing lung function and reducing the size of chylous effusions, lymphangioleiomyomas, and angiomyolipomas. However, inhibition of mTOR complex 1 increases autophagy, possibly enhancing LAM cell survival. Inhibition of autophagy with hydroxychloroquine, in combination with sirolimus, has been proposed as a possible treatment for LAM. Deficiency of tuberin results in increased RhoA GTPase activity and cell survival, an effect that is mediated through mTOR complex 2 signaling. Because sirolimus and everolimus

  1. 食管癌切除行弓上食管胃机械吻合术150例%Use of disposable pipe type stapling aortic arch anastomosis of esophagusand stomach on 150 cases of middle and lower esophageal cancer

    Institute of Scientific and Technical Information of China (English)

    贾伟; 于文江; 岳志; 常王玉


    Objective To summarize the clinical experience of using of disposable pipe type stapling aortic arch anastomosis of esophagus and stomach. Methods Retrospective analysis was made of 150 cases of middle and lower esophageal cancer resection, with disposable pipe type of stapling bow mechanical esophagogastric anastomosis. Results A hundred and forty-nine cases achieved successful, however,1 patient failed. There was one case of anastomotic bleeding. Postoperative follow-up was performed on 144 cases,3 deaths,the causes of which were anastomotic fistula,a serious infection in 1 ,and aortic esophageal fistula in 2 cases. There was chylothorax in 1 case,cured by symptomatic treatment. The other patients recovered well. Long-term anastomotic stricture appeared in 5 cases, all expanded by balloon dilator to ease or cure after 7 times. 6 cases lost. Conclusion The use of lower esophageal intercostal posterolateral left chest incision and pipe-type esophagus and stomach stapling arch anastomosis performs with surgical difficulty, but there are fewer complications and improved quality of life of patients after the stomach intestine reconstruction.%目的 探讨一次性弯管型吻合器行主动脉弓上食管胃吻合术的临床经验.方法 回顾性分析150例采用一次性弯管型吻合器行弓上食管胃机械吻合根治性切除术中、下段食管癌.结果 一次吻合成功149例,1例失败改为弓旁手工吻合.全组患者1例吻合口出血.术后随访144例,死亡3例,死亡原因:吻合口瘘、严重感染1例,食管主动脉瘘2例.,乳糜胸1例,经对症处理治愈;其余患者术后恢复良好.远期出现吻合口狭窄5例,均经球囊扩张器扩张7次后缓解或治愈.6例失访.结论 中、下段食管癌采用左胸后外侧肋间切口,使用弯管型吻合器行食管胃弓上吻合,手术难度虽较大,但术后胃肠道重建并发症较少,患者的生活质量得到提高.

  2. For the Treatment of Cavity Mirror under Improvement Ivor-Lewis Middle Segment Esophageal Squamous Carcinoma%腔镜下改良Ivor-Lewis术治疗中下段食管癌40例

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    杨文刚; 张佩文; 陈磊; 李叶娜


    gastric emptying dysfunction, 1 cases of hoarseness, chylothorax in 0 cases, no stump positive. This group of 40 cases, with no re⁃sidual positive. Lymph nodes were detected 304, the positive lymph node were 118, lymph node metastasis rate was 38.8%. Conclusion Ivor-Lewis esophageal chest surgery is a good way of surgical treatment for most patients in esopha⁃geal carcinoma and can achieve cure combined with laparoscopic surgery and obviously relieve the pain.

  3. Clinical analysis of fourteen pulmonary lymphangiomyomatosis complicated with pneumothorax patients diagnosed and treated by thoracic surgeries%胸外科诊治气胸合并肺淋巴管肌瘤病14例的临床分析

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    梁乃新; 杨华夏; 李单青


    Objective To invesligale the clinical fealures and experiences of thoracic surgeries of pulmonary lymphangiomyomatosis ( PLAM) complicated with pneumothorax patients. Methods The clinical data of 14 PLAM complicated with pneumothorax patients in Peking Union Medical College Hospital from June 1976 to August 2012 were retrospectively analyzed. Results Fourteen patients were all in young to middle-aged women with pneumothorax rate was 41. 2% (14/34). The first pneumothorax onset age was 19-46 years old,with average(33 ±2. 2)years old. 10 cases with the pneumothorax as the first manifestation were on the right side. All the patients suffered from the recurrent pneumothorax,including 11 cases had bilateral pneumothorax,even 2 cases happened simultaneously,while only 3 cases happened unilaterally. The first onset pneumothorax compression degree were 30% -90% , with an average of 60%. Amount 14 cases, only one case without complications, while the most common complications including chylothorax(6/14) , uterine fibroids ( 5/14) , pulmonary arterial hypertension(4/14) , retroperitoneal LAM (3/14) and respiratory failure(3/14). All patients' lung CT scan showed bilateral pulmonary diffuse distribution of thin walled vesicles performance, including 6 patients with pulmonary bulla. All cases have had done the thoracic closed drainage. Compared with the primary pneumothorax, patients of PLAM complicated with pneumothorax with thoracic closed drainage place more frequently,with pipe for a long time,chest tube placed difficulties,chest tube pull out difficulties. 10 cases accepted thoracic surgery,including wedge resection of lung biopsy(8/14) , pulmonary bulla resection(6/14 ) , pleural cavity adhesion operation ( 8/14 ), in which patients with simple mechanical friction adhesion(5/8) ,mechanical friclion + Lalcum powder adhesive(3/8). Amounl 10 cases accepled operations,6 cases were VATS operation and open 4 cases were open thoracic surgeries, including one bilateral VATS

  4. 单肺移植术后受者对侧自体肺并发症的分析%Complications in the native lung after single lung transplantation

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    陈乾坤; 姜格宁; 丁嘉安; 周晓; 汪浩; 陈昶; 朱余明; 王海峰; 何文新


    Objective We retrospectively reviewed 48 single lung transplants to evaluate the prognostic factors by incidence of complications arising in the native lung.Method Between 2003 and 2012,48 single lung transplants were proformed for emphysema (29 cases),pulmonary fibrosis (14 cases),lymphangioleiomyomatosis (1 case),bronchiolitis obliterans (2 cases) and pneumoconiosis (2 cases).The clinical records of the complications related to the native lung were reviewed.Result Complications in the native lung occurred in 21 patients (43.7%),leading to 17 deaths (14.6%),including pneumothorax in 2 cases (4.2%),long-term air leak after lung volume reduction surgery in 1 case (2.1%),hyperinflation in 4 cases (8.3%),chylothorax in 1 case (2.1%),lung cancer in 2 case (4.2 %),bacteria infection in 6 cases (12.5 %),and fungal infection in 5 cases (10.4%).The 1-,3-and 5-year suvival rate in recipients without or with complications in the native lung was 85%,55%,48%,and 63%,42%,21%,respectively (P<0.05).Multivariate analysis showed that infectious complications in the native lung was the independent prognostic factor (P <0.05).Conclusion After single lung transplantation,the native lung can be the source of serious problems.Infectious complications generally result in a fatal outcome,and other complications can be successfully treated in most cases,even if surgery is required.%目的 探讨单肺移植术后自体肺并发症对移植疗效和受者预后的影响.方法 回顾性分析自2003年1月至2012年8月间单中心施行的48例单肺移植的临床资料.患者的原发疾病分别为慢性阻塞性肺病29例(61%),特发性肺间质纤维化14例(29%),闭塞性细支气管炎2例(4%),尘肺2例(4%),肺淋巴管肌瘤1例(2%).分析术后对侧自体肺并发症发生情况及其预防和处理,并探讨其对受者预后的影响.结果 48例单肺移植受者中,21例(43.7%)出现了对侧自体肺并发症,其中7例(14.6

  5. 70岁以上高龄食管癌手术治疗术后并发症临床分析

    Institute of Scientific and Technical Information of China (English)

    杨力宝; 吕凯明; 罗亮; 池万忠


      Objective To explore surgery complications of the advanced age esophageal cancer patient,summary treatment experience .Methods 120 cases clinical materials of advanced age esophageal cancer patient that were colected from January 2004 to October 2010 in our hospital were retrospectively analyzed.Among them, 17 cases were in the upper portion of thoracic , 103 cases were in the middle-below portion of thoracic , the cases were divided into two groups according to surgical approaches which was the left chest into road group(58 cases) and the right chest three incision surgery group( 52 cases). Result 35cases(29.1%) had postoperative complications , 18 cases had pulmonary complications, 5 cases had anastomotic fistula , 12 cases had arrhythmia, 3 cases had gastric emptying disorder, 1 case had postoperative chest hemorrhagic, 1 case had myocardial infarction, 1 case had anastomotic stenosis, 1 case had chylothorax, 2 cases died, the surgical mortality was 1.6%.The main complications were analyzed, showing pulmonary complications for the first place, it relevant in the patient's age,operation time,surgical approach,preoperative complication and smoking, strengthen perioperative treatment can reduce pulmonary complications. Arrhythmia is the second ,it relevant in the patient who had preoperative merger hypertension,coronary heart disease, diabetes and reduced lung function and so on,should be cured in time.Anastomotic fistula is the third can be cured by strengthening the intestinal, the nutrition, dressing change-drainage. Conclusion The advanced age esophageal cancer patient who has more preoperative complications, the postoperative complications occurred frequency is higher, can reduce complications and mortality and improve the surgical treatment effects by strengthening the perioperative management and setting individualized method.%  目的探讨高龄食管癌外科手术并发症发生、治疗,总结治疗经验.方法回顾分析2004年1月至2010

  6. Lactato sérico como marcador de morbimortalidade no pós-operatório de operação de Jatene em lactentes Serum lactate as mortality and morbidity marker in infants after Jatene's operation

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    Taís Sica da Rocha


    ós a operação de Jatene, a morbidade e a mortalidade podem ser avaliadas com auxílio da dosagem de lactato sérico, sugerindo que valores aumentados na terceira hora são sugestivos de pior prognóstico.OBJECTIVE: To assess the morbidity and mortality after Jatene's operation using lactate as the main marker. METHODS: We performed a historical cohort with infants admitted in a pediatric intensive care unit during 1995 to 2005 who underwent this surgery. We assessed the preoperative, immediate (IPD, third hour (3h, six hour (6h and first day (POD1 serum lactate as well as other factors such as sepsis, increased bleeding, low cardiac output syndrome, renal insufficiency, pulmonary hypertension, cardiac arrythmias, chylothorax, myocardial ischemia, seizures, presence of other complication, and also information about length of PICU stay and death. RESULTS: The mean age of 76 patients was 14.59± 19.09 days, birth weight 3.128± 0.48 kg Forty-four patients had the diagnosis of simple transposition of great arteries. The circulatory bypass time was 143.78± 28.77 minutes and aortic clamping time of 87.68± 22.3 minutes and LOS of 20.28±15.62 days. Twenty four (31.58% died during hospital stay. Lactate increased in IPD, returning to baseline at 24 hours. Patients who died raised and maintained IPD lactate higher. The 3h lactate best discriminated mortality with area under the curve of 0.68 (CI 0.54 to 0.83 P = 0.035. However, considering a cutoff point for lactate greater or equal to 5.8 mmol/dl in the 3-h PO, we obtained only 67% sensitivity and specificity of 64% for mortality. There is positive correlation between number of complications and lactate. The low cardiac output syndrome with an odds ratio (OR of 7.67 (2.38-24, increased bleeding with OR 2.91 (1.07-7.94 and respiratory complication with OR 1.67 (1.35-2.05 are risk factors when combined. CONCLUSION: After Jatene's operation, morbidity and mortality can be assessed with the serum lactate levels, suggesting

  7. Transhiatal Esophagectomy without Thoracotomy in 105 Patients with Esophageal Cancer%非开胸食管内翻拔脱术治疗食管癌105例

    Institute of Scientific and Technical Information of China (English)

    翁文俊; 张石江; 邵永丰; 章斌


    Objective To investigate the indications, surgical techniques and postoperative complication management of transhiatal esophagectomy without thoracotomy for patients with esophageal cancer. Methods We retrospectively analyzed the clinical records of 105 patients with esophageal cancer who underwent transhiatal esophagectomy without thoracotomy in the First Affiliated Hospital of Nanjing Medical University between July 2002 and July 2010, including 28 patients who received video-assisted mediastinoscopy. There were 59 male patients and 46 female patients with their average age of 63 (48-81) years. There were 51 patients with upper thoracic esophageal cancer, 18 patients with middle thoracic esophageal cancer and 36 patients with lower thoracic esophageal cancer. Surgical outcomes and safety were evaluated. Results Mean operation time was 153 (140-210) minutes, mean intraoperative blood loss was 150 (100 to 250) ml, and mean hospital stay was 15 (10-35) days. There was no in-hospital death or residual tumor cells in esophagus stumps. Twenty-seven patients had postoperative complications, including 3 patients with anastomotic leakage at neck, 4 patients with recurrent laryngeal nerve injury, 5 patients with pleural effusion, 2 patients with pneumothorax, 3 patients with pneumonia, 3 patients with arrhythmia, 1 patient with chylothorax, 2 patients with incision infection, 2 patients with delayed gastric emptying, and 2 patients with anastomotic stenosis, who were all cured after treatment. Ninety-seven patients were followed up from 16 months to 5 years, and 8 patients were lost during follow-up. During follow-up, there were 94 patients who had lived for 1 year, 67 patients who had lived for 3 years, and 34 patients who had lived for 5 years postoperatively, and some patients needed further follow-up. Conclusion Transhiatal esophagectomy without thoracotomy is a minimally traumatic procedure and can provide fast postoperative recovery. It is especially suitable for

  8. 婴幼儿主动脉缩窄合并心内畸形一期纠治的体外循环管理方法%Cardiopulmonary bypass management methods of one stage repair of infant with aortic coarctation complicated with intracardiac malformation

    Institute of Scientific and Technical Information of China (English)

    徐红亮; 范顺阳; 杨玉齐; 李群; 石磊


    perfused in interval of 5-10 mins.PH-Stat.was used in hypothermia anda-Stat.was used in rewarming phase.Results Twenty-five cases were discharged and 2 cases died,among whom one died from pulmonary hypertension crisis the second day after operation,one died from heart failure induced by bleeding 10 hours after operation.Abnormalism hypertension occurred in 3 cases,yet no sustained hypertension was found.In the 25 cases,chylothorax,alimentary tract hemorrhage,renal failure,lower limb paraplegia were not found.Such complications as arterial aneurysm,intelligence anomaly etc,were not found during the 7 years after operation.Conclusions DHCA,necessary moderate perfusion and MUF with average blood-gas management can not only provide clear vision with less bleeding,but also can provide superior organ protection and satisfactory clinical outcome.

  9. 主动脉弓三分支覆膜支架在Stanford A型急性主动脉夹层外科治疗中的应用%The application of triple branches aortic arch stent-graft placement in the surgical treatment of acute Stanford type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    华菲; 沈振亚; 余云生; 叶文学; 黄浩岳


    was transected near the base of the innominate artery.From the incision, the triple-branched stent graft was implantated into the true lumen of the arch,descending aorta and the aorta bifurcation vessel. The transected stump of the ascending aorta was anastomosis to the proximal of the branched blood vessel prosthesis.Results Cardiopulmonary bypass time was (186 ±38) min,cross clamp time was (101 ±27) min,and average selective cerebral perfusion and lower body arrest time was ( 39 ± 11 ) min.The in-hospital mortality was zero.One patient of transient postoperative neurologic dysfunction, one of acute renal failure, one of transient limbs disturbance, one of secondary thoracotomy operation, one of gastrointestinal hemorrhage and one of postoperative chylothorax were observed.CT angiography rechecked showed the position of the vascular stent were satisfactory and the blood flow of arterial branches stents were lucid .The false lumen of the aortic arch and descending aorta closed with thrombus or shrinked.Conclusions The patients required aortic arch to be reconstructed which had no main tearing of intima in the arch may be best candidates for this technique.Open triple-branched stent graft placement combined ascending aorta replacement is an effective means for aortic arch reconstruction in acute Stanford type A aortic dissection.

  10. Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain; November 23rd-25th 2016; Session “Lung and development”

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    --- Various Authors



  11. 胎儿水肿156例临床分析%Clinical study on 156 cases with hydrops fetalis

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    林胜谋; 王晨虹; 朱小瑜; 李胜利; 林赛穆; 方群


    ultrasonography.The major etiology and associated diagnosis consisted of 35.9% (56/156) of non-immune anemia,9.6% (15/156) of cardiac abnormalities,7.1% (11/156) of intrauterine infection,6.4% (10/156) of twin problems,5.8% (9/156) of meconium peritonitis,5.1% (8/156) of thoracic-lung disease,4.5% (7/156) of chromosomal abnormalities,1.9% (3/156) of immune anemia.Alpha thalassemia was the most common non-immune anemia (96%,54/56).An etiology and associated diagnosis could be determined in 81.4% ( 127/156 ) of cases.Follow-up data showed that 7 cases were fetal death,110 women elected to terminate their pregnancies,3 cases lost follow-up,the other 36 cases preserve continuing pregnancy,including 28 liveborn infants and 8 fetal deaths.Etiology of twin-twin transfusion syndrome,meconium peritonitis,congenital chylothorax,intrauterine infection,cardiac abnormalities and so on had survived fetuscases.The survival rate of typical hydrops fetalis in the present series was 3.6% ( 4/112 ).Conclusions Ascites is the most common characteristics of sonogram in hydrops fetalis.The etiology of hydrops fetalis is extremelycomplex.The prognosis is associated with the etiology and hydrops subtype.

  12. 全胸腔镜下肺段切除术的临床应用

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    牛彦杰; 杨永珠; 李文涛


    segment 1 cases (0.98%), the upper lobe posterior segment of 14 cases (13.73%), the upper tip section 3 cases (2.94%), the upper tip posterior segment in 5 patients (4.90%), the upper tip forepart 1 cases (0.98%), the upper forepart in 3 patients (2.94%), the upper lobe posterior segment+right lower lobe 2 cases (1.96%), the right lower lobe back period of 10 cases (9.80%), the right lower lobe back period of middle+2 cases (1.96%), the right lower lobe back period before+basal segment 1 cases (0.98%), upper right posterior segment+lower right back period of+left lower back period of+left lung lower lobe basal segment 1 cases (0.98%). Results The pulmonary function of patients with MVV was 51.0-146.1 L/min, an average of (93.8±20.9) L/min, median 93.4 L/min;64.0%-125.4%, average (894.3±15.4)%, median 96.0%. The FEV 1 1.27 L-3.97 L, average (2.68 L±0.7) L, median 2.64 L;52.0%-117.9%, average (88.2 ±16.4)%, median 85.6%.There were no operation death, no early postoperative death (within 30 days). The operation time of 90 min to 330 min, average (168 ±55.1) min;median 150 min,intraoperative bleeding in 50 mL-1800 mL, average (275±402.8)mL , median 150 mL;intraoperative use of closed nailing numbers 2 to 12, with an average of (5.5±2.0),median 5;occupied size 0.3 cm-7.5 cm, an average of 2.6 cm ± 1.6 cm, with a median of 2.5 cm. Postoperative drainage volume of 100-900 mL, average ( 300.87±91.95) mL, median 275 mL.Extubation time was 2 days to 12 days, the average ( 4.83±1.42) days, median 4 days;postoperative hospital stay of 3 days to 15 days, the average ( 6.60 ± 1.76) days, median 6 days.In 1 cases of small incision thoracotomy in transit, the reason is chest widely in the adhesion. Chylothorax occurred in 1 patient, recovered after treatment.The postoperative pathological diagnosis AHH 1 case, alveolar epithelium atypical adenomatoid hyperplasia 3 patients, hamartoma 4 cases, connective tissue hyperplasia in 1, large cell carcinoma, 2 cases, tuberculosis

  13. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015; Budapest (Hungary; September 16-20, 2015; Session “Pulmonology”

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    Various Authors