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Sample records for chylothorax

  1. Noonan syndrome and chylothorax

    International Nuclear Information System (INIS)

    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

  2. Dasatinib-Related Chylothorax

    Directory of Open Access Journals (Sweden)

    Yen Min Huang

    2015-03-01

    Full Text Available Dasatinib is a potent second-generation tyrosine kinase inhibitor for the treatment of chronic myeloid leukemia. The most common adverse event associated with dasatinib therapy is fluid retention, including pleural effusion. Dasatinib-related chylothorax has rarely been reported. The clinical manifestations, pathophysiology, management, and prognosis are not fully understood. Here we report a 40-year-old woman presenting with chylothorax following dasatinib use. We propose the hypothesis of its mechanism as well as offering a review of the relevant literature.

  3. CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS.

    Science.gov (United States)

    Fernandes, Flávia Fonseca; Alves, Victor Oliveira; Sánchez, Tarquino Erastides Gavilanes; Paula, Wagner Diniz de; Santana, Alfredo Nicodemos Cruz

    2016-07-11

    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. PMID:27410917

  4. Quilotórax Chylothorax

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    Marcelo Alexandre Costa Vaz

    2006-08-01

    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.

  5. Infantile chylothorax associated with staphylococcal paravertebral discitis

    Energy Technology Data Exchange (ETDEWEB)

    Ananthakrishnan, Ganapathy; Wilkinson, Alistair G.; McGurk, Simon F. [Royal Hospital for Sick Children, Department of Radiology, Edinburgh (United Kingdom); Marshall, Thomas [Royal Hospital for Sick Children, Department of Paediatrics, Edinburgh (United Kingdom)

    2009-12-15

    We report an unusual case of chylothorax in an infant associated with a staphylococcal paravertebral abscess secondary to discitis affecting the thoracic spine. We discuss the initial presentation with sepsis and chylothorax and the delayed diagnosis of discitis. We also discuss the imaging features and treatment in this case. (orig.)

  6. Quilotórax Chylothorax

    OpenAIRE

    Marcelo Alexandre Costa Vaz; Paulo Pêgo Fernandes

    2006-01-01

    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 super...

  7. Percutaneous Management of High-Output Chylothorax: Case Reviews

    International Nuclear Information System (INIS)

    Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed using these percutaneous techniques.

  8. [Chylothorax of cirrhotic origin: a case report].

    Science.gov (United States)

    Vandenbos, F; Rakotoarisoa, C; Zeanandin, G; Mourani, A

    2005-12-01

    Chylothorax and chylous ascites are an accumulation of fluid containing a large proportion of triglycerides. The presence of these two effusions simultaneously is rare. A case of a patient with a known history of cirrhosis, hospitalized for an ascetic decompensation with left pleural effusion is herein presented. The woman was diagnosed as presenting both chylous ascites and chylothorax. Both fluids are transudate type fluids. After evacuation of the fluids and implementation of an adapted treatment neither effusion reappeared. The patient has been followed for the past year and has not shown any signs of relapse. Chylothorax, in cirrhotic patients is due to trans-diaphragmatic passage of fluid originating from the chylous ascites. Both extravasations have the same biological characteristics. PMID:16449926

  9. Chylothorax in the dog and cat

    International Nuclear Information System (INIS)

    The etiology, pathogenesis, and treatment of chylothorax are discussed in this article. A detailed discussion of thoracic duct anatomy, physiology, and methods of lymphangiography is included. The information presented is a review of previous literature, an update on recently completed studies, and speculation about where future research is needed

  10. Transudative Chylothorax in a Patient with Pulmonary Hypertension

    OpenAIRE

    Sedat Kuleci

    2016-01-01

    Chylothorax, presence of chyle in the pleural space, is an infrequent clinical form of pleural effusion developed due to several pathologies, including pulmonary hypertension. Since now, very few clinical cases of transudative chylothorax due to pulmonary hypertension have been reported. In this report, we present a transudative chylothorax case of 70-year-old female patient with pulmonary hypertension due to cardiac valvular insufficiency and right heart failure.

  11. Transudative Chylothorax in a Patient with Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Sedat Kuleci

    2016-02-01

    Full Text Available Chylothorax, presence of chyle in the pleural space, is an infrequent clinical form of pleural effusion developed due to several pathologies, including pulmonary hypertension. Since now, very few clinical cases of transudative chylothorax due to pulmonary hypertension have been reported. In this report, we present a transudative chylothorax case of 70-year-old female patient with pulmonary hypertension due to cardiac valvular insufficiency and right heart failure.

  12. New treatment of early fetal chylothorax

    DEFF Research Database (Denmark)

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

    2007-01-01

    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...... 2003-2005. Fetuses were injected with 0.2-1.0 mg of OK-432 into the pleural cavity. The treatment was repeated if there were persistent or increasing pleural effusions after 1-3 weeks. The main outcome measures included remission of pleural effusions and fetal and infant morbidity and mortality....... RESULTS: Total remission of pleural effusions was obtained in all fetuses after one or two intrapleural injections of OK-432. No adverse effects of the treatment were observed. No fetus developed hydrops, and all experienced an uncomplicated third trimester. All children were born healthy without pleural...

  13. Five Cases of Congenital Chylothorax Treated by Intrapleural Minocycline

    OpenAIRE

    Masatoshi Kaneko; Yuji Kanai; Hayato Go; Takashi Imamura; Nobuo Momoi; Mitsuaki Hosoya

    2012-01-01

    Minocycline pleurodesis was performed on five infants with congenital chylothorax in our institutions. They could not achieve sufficient efficacy though they had received other conservative therapies. Four of the five cases obtained reduction of pleural effusion using the minocycline pleurodesis. We concluded that minocycline pleurodesis is a safe and an effective technique for congenital chylothorax.

  14. Five Cases of Congenital Chylothorax Treated by Intrapleural Minocycline

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    Masatoshi Kaneko

    2012-11-01

    Full Text Available Minocycline pleurodesis was performed on five infants with congenital chylothorax in our institutions. They could not achieve sufficient efficacy though they had received other conservative therapies. Four of the five cases obtained reduction of pleural effusion using the minocycline pleurodesis. We concluded that minocycline pleurodesis is a safe and an effective technique for congenital chylothorax.

  15. Laparoscopic ligation of the thoracic duct in management of chylothorax.

    Science.gov (United States)

    Icaza, Orlando J; Andrews, Kris; Kuhnke, Mark

    2002-04-01

    Laparoscopic ligation of the cisterna chyli at the level of the aortic hiatus was performed in a 69-year-old woman with post-lobectomy chylothorax refractory to 3 weeks of conservative therapy and one repeat thoracotomy with attempted ligation of a leaking lymphatic channel. This laparoscopic procedure was successful, and resolution of the chylothorax was achieved. We feel that this technique offers surgeons a valid, minimally invasive treatment option for a persistent chylothorax in which conservative management or more direct thoracic procedures have failed to control the chyle leak. PMID:12019574

  16. Octreotide for the treatment of chylothorax in neonates.

    LENUS (Irish Health Repository)

    Das, Animitra

    2012-02-01

    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

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

    OpenAIRE

    Uma Devaraj; Priya Ramachandran; Marjorie Correa; George A D′souza

    2014-01-01

    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...

  18. Chylothorax in children, A retrospective studya€Ž

    OpenAIRE

    Amoozgar, Hamid; MEHDIZADEGAN, Nima; Ajami, Gholamhossein; BORZOUEE, Mohammad

    2010-01-01

    Background: The purpose of this study was to determine the incidence, risk factors, laboratory findings and outcomes of chylothorax in children. Material and Methods : Nemazee hospital database (affiliated hospital to Shiraz University of Medical Sciences, Shiraz, Iran) were used to identify cases with chylothorax. Medical records including records of daily management were reviewed. Results: From April 2004 to April 2009, there were 14 cases of chylothorax. Incidence of chylothorax wa...

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

    Directory of Open Access Journals (Sweden)

    Reza Saeidi

    2015-02-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-07-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Oak S

    1991-10-01

    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.

  2. [A case of X-linked myotubular myopathy with chylothorax].

    Science.gov (United States)

    Oishi, Taku; Sato, Tetsuya; Matsushita, Kenshi; Takechi, Tomoki; Murakami, Nobuyuki; Fujieda, Mikiya

    2016-01-01

    We report a case of X-linked myotubular myopathy with chylothorax. A male infant weighing 2,114 g was born to a mother whose pregnancy was complicated with polyhydramnios from gestational week 32. At gestational week 37, emergent caesarian section was performed due to membrane rupture followed by fetal bradycardia. Ventilatory support was necessary because the neonate showed severe birth asphyxia accompanied by hypotonia and dyspnea. He also showed a respiratory complication of chylothorax at 10 days old; therefore, thoracic drainage was performed. Congenital chylothorax associated with congenital myotonic dystrophy (CMD) has been described in a number of past reports. Specific findings of congenital myotubular myopathy and partial CMD, such as peripheral halo of muscle fibers, were demonstrated in biopsied muscle, and mutation of the myotubularin (MTM1) gene was identified. Tracheostomy was performed at 5 months old because of prolonged ventilatory support and severe dysphagia. The infant was able to be discharged at 17 months old. Congenital chylothorax might be associated with congenital myotubular myopathies such as CMD. PMID:27012108

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

    Directory of Open Access Journals (Sweden)

    Surya Kant

    2011-01-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lyon, Stuart, E-mail: lyonsey@optusnet.com.au; Mott, Nigel, E-mail: nigelmott76@hotmail.com; Koukounaras, Jim; Shoobridge, Jen [Alfred Hospital, Department of Radiology (Australia); Hudson, Patricio Vargas [Clinica Alemana, Department of Radiology (Chile)

    2013-06-15

    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.

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

    International Nuclear Information System (INIS)

    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.

  6. Video-assisted right supradiaphragmatic thoracic duct ligation for non traumatic recurrent chylothorax

    OpenAIRE

    Christodoulou M.

    2006-01-01

    Introduction : Un chylothorax est une pathologie comprenant des manifestations respiratoires, nutritionnelles et immunologiques. La récidive du chylothorax ou l'échec du traitement conservateur imposent un traitement chirurgical. Ce travail rapporte notre expérience de ligature supra-diaphragmatique, vidéo-assistée du canal thoracique, pour chylothorax récurrent non traumatique. Patients et méthodes : Entre 1999 et 2004, nous avons recensé six observations (quatre du côté droit, un du côté ga...

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

    Directory of Open Access Journals (Sweden)

    Adrienn Csiszkó

    2013-01-01

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    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.

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

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    Lien Van De Voorde

    2014-01-01

    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.

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

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    Mohammed Hussein

    2014-01-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2008-09-15

    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.)

  12. Chyloperitoneum and chylothorax: a combined rare occurrence after retroperitoneal lymphadenectomy and radiotherapy for testis tumor.

    Science.gov (United States)

    Dharman, K; Temes, S P; Wetherell, F E; Kendrick, M J

    1984-02-01

    We report a case of chyloperitoneum and chylothorax 5 weeks after retroperitoneal lymphadenectomy and radiotherapy for embryonal cell carcinoma of the testis. To our knowledge, this is the second reported case of this rare combined complication. The patient was treated successfully with an alimental dietary regimen (medium chain triglycerides and Vivonex), coupled with thoracenteses and paracenteses. PMID:6699970

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

    Directory of Open Access Journals (Sweden)

    Plummer Joseph M

    2007-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Summachiwakij Sarawut

    2012-06-01

    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.

  15. Localization of chyle leakage site in postoperative chylothorax by oral administration of I-123 BMIPP.

    Science.gov (United States)

    Sugiura, Kimihiko; Tanabe, Yoshio; Ogawa, Toshihide; Tokushima, Takeshi

    2005-10-01

    The authors present a 71-year-old woman who had a right chylothorax after right upper lobectomy for lung cancer. As the chylothorax was considered to be due to thoracic duct injury at the time of operation, lymphoscintigraphy was performed by oral administration of I-123 beta-methyl-iodophenyl pentadecanoic acid (BMIPP). After visualization of the stomach and intestine, abnormal accumulation of the radiotracer was found initially around the right pulmonary hilum and then spread laterally in the upper pleural cavity, indicating chyle leakage in the region of the right pulmonary hilum. Scintigraphic finding was well correlated with the subsequent thoracoscopic observation, showing chyle leakage from a lymphatic tributary near its confluence to the thoracic duct at the level of the azygos continuation. The disruption site was ligated by video-assisted-thoracoscopic-surgery procedure with successful termination of the chyle leakage. Lymphoscintigraphy by oral administration of I-123 BMIPP is thought to be a useful method for localization of chyle leakage in patients with chylothorax induced by thoracic surgery. PMID:16363625

  16. Evaluation of mesenteric lymphangiography and thoracic duct ligation in cats with chylothorax: 19 cases (1987-1992)

    International Nuclear Information System (INIS)

    Mesenteric lymphangiography and thoracic duct ligation were performedon 19 cats with chylothorax between 1987 to 1992. Chylothorax was diagnosed on the basis of detection of chylomicrons in the pleural effusion or determination of a cholesterol concentration:triglyceride concentration ratio of 12 months after surgery. Four cats died between 2 and 13 days after thoracic duct ligation, but pleural effusion had resolved in 3 of these 4 cats at the time of death. Five cats were euthanatized 8 to 36 days after surgery because of persistent chylous effusion after thoracic duct ligation

  17. Use of mesenteric lymphangiography in a calf with chylothorax and chyloperitoneum

    International Nuclear Information System (INIS)

    Lymphatic abnormalities resulting in chylous effusion into a body cavity are uncommon in domestic animals. In a 6-day-old calf admitted to our hospital because of failure to suckle and abdominal distention, however, mesenteric lymphangiography revealed an obstruction of lymphatic flow. Laparoscopic examination of the abdomen was unsuccessful. Fluid accumulation was resolved in this calf by drainage. In cattle with chylothorax and concurrent chyloperitoneum in which a traumatic lesion of the thoracic duct is possible, conservative management, with drainage and supportive treatment, should be attempted prior to considering surgical intervention

  18. [Thoracic duct collaterals of lymphatic and pulmonary origin. Anatomy and chylothorax after pulmonary surgery].

    Science.gov (United States)

    Riquet, M; Hidden, G; Debesse, B

    1989-01-01

    Dye injection of lung segments reveals the existence of lymphatic drainage of the lungs generally into cervical venous confluents and more rarely into the arch of the thoracic duct in the neck and also occasionally into the thoracic duct in the mediastinum. Direct drainage of the lymph into the thoracic duct was observed in 10 cases out of a series of 589 injections of lung segments in adult cadavers. In one half of cases, the thoracic duct was injected from the left suprabronchial lymph node chain, the origin of the left recurrent chain, and in one quarter of cases from the lateral anteroposterior right major azygos and left azygo-aortic lymph node chains, not recognised by the classical authors. More rarely, direct lymphatic collaterals drained certain segments of the lower lobes into the thoracic duct via the triangular ligament. Analysis of cases of chylothorax occurring after lung resection and observed in the authors' department or in the literature reveals that most of them can be attributed to a chyle leak from one of these pulmonary lymph collaterals. These pathways are probably also involved in the development of medical or idiopathic chylothorax. PMID:2686514

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

    Directory of Open Access Journals (Sweden)

    Finsterer J

    2013-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Lucía Llames

    2009-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Luiz Felipe Lopes Araujo

    2009-04-01

    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.

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

    Directory of Open Access Journals (Sweden)

    E. Medina

    2005-12-01

    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.

  3. Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax

    International Nuclear Information System (INIS)

    Post operative chylothorax is a known complication of various thoracic surgeries. It needs identification of precise site of leak in the thoracic duct. Lymphosicintigraphy can identify chyle leak but cannot delineate exact site of leak. SPECT-CT is precise in anatomic localisation and hence SPECT-CT should be combined with every lymphoscintigraphy in evaluation of clinically suspected case of post operative chylothorax. We report such a case

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2002-07-01

    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.)

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

    Directory of Open Access Journals (Sweden)

    José Carlos Miranda Torrejais

    2006-12-01

    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.

  6. Nursing caring 3 cases of adolescents complicated by postoperative chylothorax after serious scoliosis correction surgery%3例青少年严重脊柱侧弯矫形术后并发乳糜胸的护理

    Institute of Scientific and Technical Information of China (English)

    李婷; 王文妍

    2015-01-01

    乳糜胸(chylothorax)是脊柱外科的少见并发症,若忽视可致严重后果。笔者回顾了3例青少年严重脊柱侧弯矫形术后并发乳糜胸的护理方法。通过术后采取半卧位及保护脊柱凸侧切口处皮肤等护理措施可明显提高乳糜胸的治疗效果。%Chylothorax is a rare complication in spine surgery, neglect can cause serious consequences. This paper reviewed the nursing methods for 3 cases of adolescents complicated by postoperative chylothorax after serious scoliosis correction surgery. Through taking measures, e.g. semireclining position and protecting skins at cutting edge, etc, treatment effect could be obviously enhanced.

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

    Directory of Open Access Journals (Sweden)

    Mónica Zagolín B

    2004-04-01

    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. Quilotórax persistente en paciente con linfangioleiomiomatosis Persistent chylothorax in patient with lymphangioleiomyomatosis

    OpenAIRE

    R. Palmeiro; V. Arosa; C. Cuerda; I. Bretón; M. Camblor; M.ª C. Rodríguez; P. García Peris

    2012-01-01

    La linfangioleiomiomatosis (LAM) es una enfermedad poco frecuente que afecta a mujeres en edad fértil y presenta una evolución sistémica progresiva, siendo el pulmón y los ganglios mediastínicos los órganos más afectados. La afectación pulmonar se caracteriza por disnea, derrame pleural, hemoptisis y neumotórax espontáneo, siendo el quilotórax una complicación frecuente en el curso evolutivo de esta enfermedad, produciéndose hasta en el 30% de casos. El tratamiento del quilotórax no está esta...

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

    Directory of Open Access Journals (Sweden)

    Rottoli Matteo

    2012-01-01

    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.

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

    OpenAIRE

    Finsterer J; Stollberger C; Stubenberger E; Tschakoschian S

    2013-01-01

    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 o...

  11. Gastric signet-ring cell adenocarcinoma presenting with left arm deep-vein thrombosis and bilateral chylothorax.

    Science.gov (United States)

    Kayacan, Oya; Karnak, Demet; Ayşe Can, Berna; Dizbay Sak, Serpil; Beder, Sumru

    2008-10-01

    A 28-year-old housewife, a life-long nonsmoker, presented with 3 weeks of pleuritic chest pain along with swollen right leg, left arm, and left breast. Six months previously she had left subclavian vein thrombosis. On admission, bilateral supraclavicular lymphedema on right leg and left arm and breast was observed and bilateral pleural fluid, chylous exudates, was detected. Abdomen computed tomography revealed abundant ascites and right ovarian enlargement. Whole body bone scintigraphy showed bone metastases on left humerus, right femur, and pelvis. Bronchial biopsy, obtained from edematous, hyperemic-irregular mucosa, revealed a carcinoma composed of signet-ring cells with intracytoplasmic mucin. Breast biopsy also showed signet-ring cells within the lymphatics. Pleural fluid cytology showed similar malignant cells. The patient was diagnosed as gastric signet-ring cell adenocarcinoma with endobronchial, mammary, ovarian, pleural, pericardial, peritoneal, and osteal metastases. The authors recommend that deep-vein thrombosis in unusual sites deserves further evaluation for an occult malignancy. PMID:18263634

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

    OpenAIRE

    Chen Yen-Hsu; Lai Chung-Hsu; Lin Jiun-Nong; Chang Lin-Li; Lee Susan; Lin Hsi-Hsun

    2010-01-01

    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 cop...

  13. Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy

    Directory of Open Access Journals (Sweden)

    Alampath Praveen

    2012-01-01

    Full Text Available Thoracic duct embolization (TDE is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct.

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

    OpenAIRE

    José Carlos Miranda Torrejais; Carolina Borges Rau; João Adriano de Barros; Márcia Miranda Torrejais

    2006-01-01

    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 con...

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

    OpenAIRE

    Mónica Zagolín B; Anabella Aguilera S; Mladen Vojkovic L

    2004-01-01

    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 t...

  16. Måling af pH i pleuravæske er af værdi ved udredning af årsagen til purulent pleuraeffusion

    DEFF Research Database (Denmark)

    Rømhild Davidsen, Jesper; Laursen, Christian Borbjerg; Madsen, Poul Henning

    2012-01-01

    pleural effusions, had thoracocentesis performed with drainage of purulent pleural fluid (plf) after preceding symptoms of pneumonia. Pleural empyema was suspected. However, a plf-pH-measurement of 7.3 made this diagnose less likely. A subsequent analysis of plf revealed an elevated plftriglyceride...... concentration, thus confirming chylothorax. In order to distinguish between pleural empyema and chylothorax plf-pH should be considered as a routine analysis in patients with underlying malignancy and drainage of purulent pleural fluid....

  17. Magnetic Resonance Imaging Findings in Diffuse Lymphangiomatosis: Neuroradiological Manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Ozturk, A.; Yousem, D.M. [Russell H. Morgan Dept. of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States)

    2007-07-15

    We report magnetic resonance (MR) findings in a patient with histologically proven lymphangiomatosis with a history of chylothorax, diffuse lung infiltrates, spinal involvement, cystic lesions of the mediastinum, and mesentery thickening. The patient also had diffuse infiltration of the right brachial plexus, with similar imaging findings as the spinal lesions. Although osseous and extraosseous involvement may be seen frequently with lymphangiomatosis, involvement of the brachial plexus has not been previously reported.

  18. Minimally Invasive Tracheal Resection: Cervical Approach Plus Video-Assisted Thoracoscopic Surgery.

    Science.gov (United States)

    Lonie, Sarah J; Ch'ng, Stephanie; Alam, Naveed Z; Wright, Gavin M

    2015-12-01

    Tracheal resection for adenoid cystic carcinoma (ACC) is a well-documented procedure. Surgical resection of these lesions offers patients the greatest potential chance of survival. Midtracheal tumors are usually resected through a maximally invasive sternotomy or thoracotomy. We report a midtracheal resection of a symptomatic ACC in a 25-year-old man by video-assisted thoracoscopic hilar release and suprasternal anastomotic approaches. The patient's recovery was complicated by chylothorax and pneumonia. PMID:26652526

  19. Lymphangioleiomyomatosis

    International Nuclear Information System (INIS)

    Background. Lymphangioleiomyomatosis is a rare disease of unknown origin, which affects women in their reproductive period. It is characterised by non-neoplastic proliferation of atypical smooth muscle cells in the lung parenchyma, lymphatic vessels and mediastinal and abdominal lymph nodes. The most common presenting symptoms are spontaneous pneumothorax, dyspnea, hemoptysis and chylothorax. Conclusions. High-resolution computed tomography (HRCT) and open lung biopsy followed by the immunohistologic studies are two diagnostic procedures with which diagnosis can be confirmed. Various treatment modalities are applied, particularly hormonal therapy, though their efficacy remain unknown. The prognosis of patients is bad. (author)

  20. Spontaneous chyloptoe due to lymphangiectasis of the pulmonary lymph vessels

    International Nuclear Information System (INIS)

    Chylopulmo is a term introduced by Dobbertin and Hulzy for this relatively rarely observed phenomenon. It is characterized by a chylons infiltration of the lungs, not primarily forming part of a chylothorax, but possibly inducing it. For correct diagnosis, lymphography is to be completed by CT scanning, as this technique detects uptake of contrast medium by the lymphocysts. Ligature of the ductus thoracicus seems to be the therapy of choice. If surgery is not possible, a largely fat-free diet may reduce the complaints. (orig./GDG)

  1. Iatrogenic causes of large pleural fluid collections in the premature infant: Ultrasonic and radiographic findings

    International Nuclear Information System (INIS)

    Ten cases of large pleural collections, all of which were iatrogenically induced in premature infants, are presented. There were five instances of hypopharyngeal tears communicating with the right pleural space, three of chylothorax secondary to superior vena caval obstruction in patients undergoing total parenteral nutrition catheterization (TPN), and two of direct erosion by and inferior vena caval TPN catheter into the pleural space. Ultrasonography was most helpful in detecting these pleural collections. It is important to recognize the presence of pleural fluid in these infants as a marker of iatrogenic injury. (orig.)

  2. Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography.

    Science.gov (United States)

    Kim, Eun Young; Hwang, Hye Sun; Lee, Ho Yun; Cho, Jong Ho; Kim, Hong Kwan; Lee, Kyung Soo; Shim, Young Mog; Zo, Jaeil

    2016-03-01

    Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.Ten patients (age range 42-72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems. PMID:27015184

  3. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    International Nuclear Information System (INIS)

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  4. Unusual cause of shortness of breath after surgery for thoracic outlet syndrome

    Science.gov (United States)

    Schroeder, Jonathan Ryan; Kumar, Anjan; Savage, Edward; Rahaghi, Franck F

    2012-01-01

    A 31-year-old postal worker was diagnosed with bilateral thoracic outlet syndrome and scheduled for the first of two surgeries. The first procedure involved removal of the right first cervical rib, anterior and middle scalenes. On postoperative day 4, he developed shortness of breath. Chest radiograph showed a new pleural effusion on the right. Thoracentesis revealed a yellowish-red thick effusion. Based on the initial look of the fluid it was thought to be a haemorrhagic effusion with a purulent component, further testing revealed that he had developed a chylothorax. The patient was placed on a medium-chain triglyceride diet followed by chest tube drainage. After one day, the chest tube was removed due to minimal drainage, and he was discharged home the next day. Keeping this patient without food, on total parental nutrition, or pursuing surgical intervention was not necessary, as he had an excellent outcome from a very rare surgical complication. PMID:23047993

  5. Advances in Video-Assisted Thoracic Surgery, Thoracoscopy.

    Science.gov (United States)

    Case, Joseph Brad

    2016-01-01

    Video-assisted thoracic surgery (VATS) is an evolving modality in the treatment and management of a variety of pathologies affecting dogs and cats. Representative disease processes include pericardial effusion, pericardial neoplasia, cranial mediastinal neoplasia, vascular ring anomaly, pulmonary neoplasia, pulmonary blebs and bullae, spontaneous pneumothorax, and chylothorax. Several descriptive and small case reports have been published on the use of VATS in veterinary medicine. More recently, larger case series and experimental studies have revealed potential benefits and limitations not documented previously. Significant technological advances over the past 5 years have made possible a host of new applications in VATS. This article focuses on updates and cutting-edge applications in VATS. PMID:26410560

  6. Human Milk for Ill and Medically Compromised Infants: Strategies and Ongoing Innovation.

    Science.gov (United States)

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

    2016-08-01

    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. PMID:26903304

  7. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

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    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

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

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    Mohammadtaghi Rajabi Mashhadi

    2015-07-01

    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.

  9. Lymphangioleiomyomatosis: differential diagnosis and optimal management

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    Xu KF

    2014-08-01

    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

  10. Tube Thoracostomy: Complications and Its Management

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    Emeka B. Kesieme

    2012-01-01

    Full Text Available Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.

  11. Tube thoracostomy: complications and its management.

    Science.gov (United States)

    Kesieme, Emeka B; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

    2012-01-01

    Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

  12. Acute onset of bilateral visual loss during sildenafil therapy in a young infant with congenital heart disease

    Science.gov (United States)

    Gaffuri, Marcella; Cristofaletti, Alessandra; Mansoldo, Caterina; Biban, Paolo

    2014-01-01

    We report a case of posterior non-arteritic ischaemic optic neuropathy (NAION) causing bilateral visual loss in a 7-month-old female infant, after a therapeutic course with sildenafil, a phosphodiesterase type 5 inhibitors (PDE5i). The patient was affected by a complex cyanotic congenital heart defect and had undergone cavopulmonary anastomosis (Glenn operation) 3 months ago. After 2 months of recurring chylothorax, a course of oral sildenafil was administered, with the hypothesis that pulmonary vascular resistances were increased. Approximately 4 weeks later the acute onset of visual worsening and poor pupillary light reflex prompted the diagnosis of posterior NAION. Despite a rapid cessation of PDE5i and systemic treatment with corticosteroids, no visual recovery was noticed at 2-year follow-up. NAION has been associated with PDE5i therapy in adults, but to the best of our knowledge it is almost unheard of in children. We suggest close monitoring of visual function in children undergoing treatment with sildenafil. PMID:24895393

  13. Surgical Interventions and Complications After Surgery in Newborns

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    F Eghbalian

    2005-09-01

    Full Text Available Background: Early diagnosis and treatment of neonatal disease, particulary the surgical disease has great importance. Methods: We had studied the neonatal diseases needed to surgical treatment, associated anomalies, medical treatment, short-term complications and mortality in a period of October 2002 to October 2004 in NICU of Ekbatan hospital. Findings: We studied 126 surgeried neonate in a prospective descriptive study, 63.5% were male. The diseases were: Hirshprung 19.0%, imperforated anus 16.7%, esophageal atresia 18.7%, inguinal hernia 9.5%, clef lip 6.3%, omphalocele 4.0%, meconium ileus 3.96%, jugenal atresia, necrotizing enterocolitis and meningomyelocele 1.58%, pneumothorax, chylothorax, sacrocoxygeal teratoma, hepatoblastoma, ovarian cyst, mechels diverticulum, gastrochesia, thyroglosal duct cyst, cystic hygroma, posterior urethral valve has 0.79% frequency in our study. We didn’t find any associated anomaly in 58.73% of our cases. Electrolyte abnormality was the most post-operative complication, majority of them needed to medical treatment. In this study, mortality rate was 10.3%. Conclusion: Our study revealed that NICU, appropriate surgical techniques, appropriate pre&post operative medical treatment has dramatic effect in improving their outcome and diminishing surgical complications.

  14. Gorham-Stout syndrome of the spine. Case report and review of literature

    International Nuclear Information System (INIS)

    Two female patients with Gorham-Stout syndrome (GSS) of the spine are described. One 25 year old patient developed progressive osteolysis of the upper cervical spine over a period of several years but despite gross extent of the disease had no neurological complications. Some bone implanted in order to stabilise the spine was absorbed after only a few weeks. A six year old girl with progressive osteolysis of the thoracic spine developed a reversible trans-section syndrome on several occasions. During an active episode, the spine was stabilised by a titanium implant. In both patients the condition arrested spontaneously. A review of the world literature (175 cases) has indicated that, including our two patients, there were only 15 patients with primary involvement of the spine and 27 patients with secondary involvement. The relatively good prognosis of the condition (mortality 13.3%), which often shows spontaneous arrest, becomes much worse if there is involvement of the spine or thorax because of neurological complications or a chylothorax. Involvement of the spine increases mortality to 33.3%, and to 52% if the thorax is involved. Early diagnosis and the institution of appropriate treatment is therefore essential. For involvement of the spine, a combination of radiotherapy and surgical stabilisation with a titanium implant should be performed since in nearly all patients bone transplants are reabsorbed. For this treatment the patient should be transferred to a neuro-orthopaedic centre. (orig.)

  15. Hidrotórax fetal primario: manejo antenatal.

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    Luis Díaz Guerrero

    2015-08-01

    Full Text Available Fetal hydrothorax (FH is the presence of fluid in the pleural cavity of the chest. It may be isolated or associated with fetal hydrops and ascites. The incidence 1: 15,000 pregnancies If it is isolated, the most common cause is congenital chylothorax primary abnormality of the lymphatic system. In Newborn (RN is common in males, usually bilateral primary and sex. In the fetus is secondary with prevalence 1: 1500 live births caused by isoimmunization, infections, heart disease, chromosomal abnormalities, malformations of placenta and umbilical cord. The average age of diagnosis is 27 weeks, ultrasonographically recognized as an anechoic area around the lungs. His prognosis mainly depends on the cause and secondarily of its size, laterality and presence of hydrops. The mortality is estimated at 25%, varying from 15% when it is isolated and 95% associated with hydrops. Most worsen bilateral becoming pregnancy can generate esophageal compression in primary fetal Hydrothorax (HFP associated with polyhydramnios 72%. HFP case is reported, a patient of 20 years with 25 weeks of gestation, whose ultrasonographic finding documents right pleural effusion, intrauterine thoracentesis is done, obtaining 25cc yellowish liquid, then no decrease in the pleural effusion. It was obtained segmental elective Caesarean at 37 weeks + 6 days; Female RN in stable conditions did not require intubation or artificial ventilatory support. Intrauterine evacuation intrathoracic pressure relieved, allowing a satisfactory expansion of both lungs and respiratory distress avoiding RN

  16. Radiographic imaging features of thoracic complications after pneumonectomy in oncologic patients

    International Nuclear Information System (INIS)

    Purpose: The morbidity and mortality for pneumonectomy in patients has been reported to be as high as 24%. To determine if a subset of patients undergoing pneumonectomy for a malignancy would have similar complication rates and appearances, we performed a review of the radiographic findings of patients at our institution. Method: A retrospective review of a thoracic surgery database was performed at our institution for patients who underwent pneumonectomy between January 2001 and April 2004. All images were reviewed on the institutional patient archive communication system, by two experienced, fellowship trained, thoracic radiologists. Results: There were 144 patients (112 men and 32 women) with a mean age of 52 years (range 21–83 years). Of the 144 patients, thoracic complications were present in 52 (36%) patients consisting of pneumonia in 19 (13%), empyema/pleural space infection in 9 (6%), adult respiratory distress syndrome (ARDS) in 8 (6%), bronchopleural fistula in 7 (5%), gortex graft failure/organ herniation in 4 (3%), chylothorax/chyle leak in 2 (1%), pulmonary embolus in 2 (1%), pulmonary hemorrhage in 1 (<1%). Conclusion: In oncologic patients, post-pneumonectomy complications occur in over a third of patients and can be life threatening. The presentations are similar to other pneumonectomy patients and are often radiographically detectable. Therefore it is important for radiologist to be aware of the radiographic manifestations of these complications so that appropriate immediate treatment is instituted.

  17. Gorham-Stout syndrome of the spine. Case report and review of literature; Das Gorham-Stout-Syndrom der Wirbelsaeule. Fallbericht und Literaturuebersicht

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    Floerchinger, A.; Boettger, E.; Claass-Boettger, F. [Klinikum Karlsbad-Langensteinbach (Germany). Abt. fuer bildgebende Verfahren; Georgi, M. [Inst. fuer Klinische Radiologie, Fakultaet fuer Klinische Medizin, Heidelberg Univ., Mannheim (Germany); Harmes, J. [Abt. fuer Orthopaedie, Wirbelsaeulenchirurgie, Klinikum der Stadt Mannheim (Germany)

    1998-01-01

    Two female patients with Gorham-Stout syndrome (GSS) of the spine are described. One 25 year old patient developed progressive osteolysis of the upper cervical spine over a period of several years but despite gross extent of the disease had no neurological complications. Some bone implanted in order to stabilise the spine was absorbed after only a few weeks. A six year old girl with progressive osteolysis of the thoracic spine developed a reversible trans-section syndrome on several occasions. During an active episode, the spine was stabilised by a titanium implant. In both patients the condition arrested spontaneously. A review of the world literature (175 cases) has indicated that, including our two patients, there were only 15 patients with primary involvement of the spine and 27 patients with secondary involvement. The relatively good prognosis of the condition (mortality 13.3%), which often shows spontaneous arrest, becomes much worse if there is involvement of the spine or thorax because of neurological complications or a chylothorax. Involvement of the spine increases mortality to 33.3%, and to 52% if the thorax is involved. Early diagnosis and the institution of appropriate treatment is therefore essential. For involvement of the spine, a combination of radiotherapy and surgical stabilisation with a titanium implant should be performed since in nearly all patients bone transplants are reabsorbed. For this treatment the patient should be transferred to a neuro-orthopaedic centre. (orig.) [Deutsch] Es werden zwei Patientinnen mit Gorham-Stout-Syndrom (GSS) der Wirbelsaeule (WS) vorgestellt. Eine 25jaehrige Patientin mit mehrjaehriger, progredienter Osteolyse der oberen HWS entwickelte trotz erheblicher Fehlstellung keine neurologische Komplikation. Ein zur Stabilisierung implantierter Knochenspan wurde nach wenigen Wochen resorbiert. Bei einem 6jaehrigen Maedchen mit progredienter Osteolyse der BWS kam es mehrmals zu einem reversiblen Querschnittssyndrom

  18. Pulmonary Complications due to Esophagectomy

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    Yashar Talebi

    2011-08-01

    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.

  19. RASA1 somatic mutation and variable expressivity in capillary malformation/arteriovenous malformation (CM/AVM) syndrome.

    Science.gov (United States)

    Macmurdo, Colleen F; Wooderchak-Donahue, Whitney; Bayrak-Toydemir, Pinar; Le, Jenny; Wallenstein, Matthew B; Milla, Carlos; Teng, Joyce M C; Bernstein, Jonathan A; Stevenson, David A

    2016-06-01

    Germline mutations in RASA1 are associated with capillary malformation-arteriovenous malformation (CM-AVM) syndrome. CM-AVM syndrome is characterized by multi-focal capillary malformations and arteriovenous malformations. Lymphatic anomalies have been proposed as part of the phenotype. Intrafamilial variability has been reported, suggesting modifiers and somatic events. The objective of the study was to identify somatic RASA1 "second hits" from vascular malformations associated with CM-AVM syndrome, and describe phenotypic variability. Participants were examined and phenotyped. Genomic DNA was extracted from peripheral blood on all participants. Whole-exome sequencing was performed on the proband. Using Sanger sequencing, RASA1 exon 8 was PCR-amplified to track the c.1248T>G, p.Tyr416X germline variant through the family. A skin biopsy of a capillary malformation from the proband's mother was also obtained, and next-generation sequencing was performed on DNA from the affected tissue. A familial germline heterozygous novel pathogenic RASA1 variant, c.1248T>G (p.Tyr416X), was identified in the proband and her mother. The proband had capillary malformations, chylothorax, lymphedema, and overgrowth, while her affected mother had only isolated capillary malformations. Sequence analysis of DNA extracted from a skin biopsy of a capillary malformation of the affected mother showed a second RASA1 somatic mutation (c.2245C>T, p.Arg749X). These results and the extreme variable expressivity support the hypothesis that somatic "second hits" are required for the development of vascular anomalies associated with CM-AVM syndrome. In addition, the phenotypes of the affected individuals further clarify that lymphatic manifestations are also part of the phenotypic spectrum of RASA1-related disorders. © 2016 Wiley Periodicals, Inc. PMID:26969842

  20. Direct lymphangiography as treatment option of lymphatic leakage: Indications, outcomes and role in patient's management

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    Gruber-Rouh, Tatjana, E-mail: tgruberrouh@googlemail.com [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Naguib, Nagy N.N. [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria (Egypt); Lehnert, Thomas; Harth, Marc; Thalhammer, Axel; Beeres, Martin [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Tsaur, Igor [Department of Urology, Johann Wolfgang Goethe University Frankfurt, Frankfurt am Main (Germany); Hammersting, Renate; Wichmann, Julian L.; Vogl, Thomas J.; Jacobi, Volkmar [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany)

    2014-12-15

    Background: To evaluate the effectiveness of lymphography as a minimally invasive treatment option of lymphatic leakage in terms of local control and to investigate which parameters influence the success rate. Method: This retrospective study protocol was approved by the ethic committee. Patient history, imaging data, therapeutic options and follow-up were recorded and retrospectively analyzed. Between June 1998 and February 2013, 71 patients (m:w = 42:29, mean age, 52.4; range 42–75 years) with lymphatic leakage in form of lymphatic fistulas (n = 37), lymphocele (n = 11), chylothorax (n = 13) and chylous ascites (n = 10) underwent lymphography. Sixty-four patients (90.1%) underwent successful lymphography while lymphography failed in 7 cases. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage and to the volume of the applied iodized oil. Result: Signs of leakage or contrast extravasation were directly detected in 64 patients. Of 64 patients, 45 patients (70.3%) were treated and cured after lymphography. Based on the lymphography findings, 19 patients (29.7%) underwent surgical intervention with a completely occlusion of lymphatic leakage. The lymphatic leak could be completely occluded in 96.8% of patients when the lymphatic drainage volume was less than 200 mL/day (n = 33). Even when lymphatic drainage was higher than 200 mL/day (n = 31), therapeutic lymphography was still successful in 58.1% of the patients. Conclusion: Lymphography is an effective, minimally invasive method in the detection and treatment of lymphatic leakage. The volume of lymphatic drainage per day is a significant predictor of the therapeutic success rate.

  1. Therapeutic applications of octreotide in pediatric patients

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    Abdulrahman Al-Hussaini

    2012-01-01

    Full Text Available Background/Aim: We report our experience with the use of octreotide as primary or adjunctive therapy in children with various gastrointestinal disorders. Patients and Methods: A pharmacy database identified patients who received octreotide for gastrointestinal diseases. Indications for octreotide use, dosing, effectiveness, and adverse events were evaluated by chart review. Results: A total of 21 patients (12 males, aged 1 month to 13 years, were evaluated. Eleven received octreotide for massive gastrointestinal bleeding caused by portal hypertension-induced lesions (n=7, typhlitis (1, Meckel′s diverticulum (1, and indefinite source (2. Blood transfusion requirements were reduced from 23±9 mL/kg (mean±SD to 8±15 mL/kg (P<0.01. Four patients with pancreatic pseudocyst and/or ascites received octreotide over 14.0±5.7 days in 2 patients. In 3 children, pancreatic pseudocyst resolved in 12±2 days and pancreatic ascites resolved in 7 days in 2. Three patients with chylothorax received octreotide for 14±7 days with complete resolution in each. Two infants with chronic diarrhea received octreotide over 11±4.2 months. Stool output decreased from 85±21 mL/kg/day to 28±18 mL/kg/day, 3 months after initiation of octreotide. The child with dumping syndrome responded to octreotide in a week. Adverse events developed in 4 patients: Q-T interval prolongation and ventricular fibrillation, hyperglycemia, growth hormone deficiency, and hypertension. Conclusion: Octreotide provides a valuable addition to the therapeutic armamentum of the pediatric gastroenterologist for a wide variety of disorders. Serious adverse events may occur and patients must be closely monitored.

  2. 胸腰段脊柱前路手术并发症的临床防治分析%Prevention and Treatment of Anterior Thoracic and Lumbar Spine Clinical Complications

    Institute of Scientific and Technical Information of China (English)

    刘胜刚

    2011-01-01

    目的:探讨胸腰段脊柱前路手术并发症的术中预防和术后治疗。方法:对39例胸腰段脊柱骨折患者行前路减压及内固定术,观察术后并发症的发生及其治疗过程与转归。结果:39例患者中,气胸、乳糜液漏和切口疝均有1例,经过及时治疗,均于术后2周内治愈且顺利出院,术后半年至一年回访,均恢复良好。结论:胸腰段脊柱前路手术手术过程复杂,应充分做好手术准备,术中应谨慎操作预防并发症发生,术后严密观察患者病情变化,从而及时采取治疗措施,提高治愈率。%Objective:To explore the road before rachis lumbav intraoperative complications of prevention and postoperative therapy.Methods:39 cases chest lumbav spine fracture patients underwent anterior decompression and fixation,observe the postoperative complications of occurrence and treatment peocess and outcome.Results:Thirty-nine patients,pneumothorax,liquid leakage and incision hemia chylothorax are 1 case ,after treatment,after two weeks in all healing and smooth discharge.after six months to one year for return visit,all good recovery.Conclusions:The thoracic spine lumbav road before surgery surgical process in complicated,should make full preparations,completes the surgery intraoperatie caution should operate to prevent complications occurred and the strict observation patient condition changes,thus take timely treatment measures to increase the curative rate.

  3. Clinical features, epidemiology, and therapy of lymphangioleiomyomatosis

    Directory of Open Access Journals (Sweden)

    Taveira-DaSilva AM

    2015-04-01

    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

  4. Linfangioleiomiomatosis pulmonar

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    Carlos Salazar-Vargas

    2000-09-01

    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

  5. Video-assisted thoracoscopic surgery for mediastinal tumors%电视胸腔镜手术治疗纵隔肿瘤的临床分析

    Institute of Scientific and Technical Information of China (English)

    韦武芝; 刘宝珊; 吴伟斌; 吕文强; 张志锋

    2014-01-01

    ,complications,follow-up results were observed.Results The operation time was shorter in the VATS group than in the thoracotomy group.There were statistical differences (P < 0.005) in anaesthetic time,operative bleeding volume,postoperative antibiotics consumption,postoperative analgesia time,postoperative tracheal extubation time,postoperative hospital stay,and total inpatient costs between the 2 groups.There was no statistical difference in incidence of postoperative complications between the two groups.In VATS group,the average anaesthetic time was (4.31 ± 1.19) h,the average operative bleeding volume was (65.38 ± 57.71) ml,the average postoperative antibiotics consumption was (2.42 ± 0.70) d,the average postoperative analgesia time was (2.58 ± 0.95) d,the average postoperative tracheal extubation time was (4.04 ± 3.75) d,the average postoperative hospital stay was (6.58 ± 5.78) d,and the average total inpatient cost was (2.69 ± 0.89) ten thousand yuan.After the operation,one case occurred chylothorax,one case had pneumonia,and no case died.Conclusions VATS has advantages of sufficient exposure of surgical fields,safety and reliability,lower bleeding volume,minimal invasiveness,mild pain,little physiology disturbance,fewer complications,short hospitalization time,rapid recovery,small cut and cosmetic results.It can be used as an important program for mediastinal tumors whenever possible.

  6. 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

    Institute of Scientific and Technical Information of China (English)

    梁乃新; 杨华夏; 李单青

    2013-01-01

    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

  7. Application of delayed sternal closure in surgery for children with complex congenital heart disease%延迟关胸技术在小儿复杂先天性心脏病手术中的应用

    Institute of Scientific and Technical Information of China (English)

    刘洋; 张刚成; 卢蓉; 余莹

    2015-01-01

    Objective To discuss the application value of delayed sternal closure in surgery for children with complex congenital heart disease. Methods A total of 79 children with complex congenital heart disease accepted delayed sternal closure after operations,including 36 cases of Switch operation,25 cases of TOF surgery,7 cases of TAPVC,3 cases of Rastelli operation,2 cases of palliative reconstruction of right ventricular outflow tract,2 cases of Nikaidoh operation,1 case of bidirectional Glenn operation,2 cases of aortic arch plasty and 1 case of aortopulmonary window repair. Results After delayed sternal clo-sure,there were 36 cases(45. 57% )of myocardial tissue edema,28 cases(35. 44% )of acute renal dam-age,28 cases(35. 44% )lung infection,22 cases(27. 85% )of severe wound bleeding,12 cases(15. 19% ) cases of pulmonary hemorrhage,8 cases(10. 13% )of acute liver damage,5 cases of high grade A-V block (6. 33% ),2 cases(2. 53% )of urinary tract infection and 1 case(1. 27% )in each of perfusion lung,deep vein thrombosis,paralytic ileus,diaphragmatic paralysis,intracranial hypertension and chylothorax. The av-erage open time of the sternum was(62. 2 ± 9. 3)h. There were 73 cases(92. 41% )of successful delay sternal closure and 6 cases(7. 59% )of death. Conclusion Delayed sternal closure is a simple,safe and effective solution for postoperative bleeding,myocardial edema,low cardiac output syndrome while does not increase the incidence of wound infection.%目的:探讨延迟关胸技术在小儿复杂先天性心脏病手术中的应用价值。方法小儿复杂先天性心脏病术后延迟关胸79例,其中大动脉调转(Switch)术36例,法洛四联症(TOF)根治术25例,完全肺静脉异位引流(TAPVC)矫治术7例,心室内隧道外管道(Rastelli)术3例,姑息右室流出道疏通术2例,主动脉移植(Nikaidoh)术2例,双向上腔肺动脉连接(Gleen)术1例,主动脉弓部成形术2例,主肺动脉窗修补术1例

  8. Analysis on the Etiologies and Clinical Characteristics of 173 Cases of Pleural Effusion in Children%173例小儿胸腔积液临床特点分析

    Institute of Scientific and Technical Information of China (English)

    徐丽丹; 罗运春

    2011-01-01

    and treatment of children. Methods The clinical data of 173 cases who diagnosed with pleural effusion by chest radiology and( or) chest Bultration hospitalizcd from Jaunary 2004 to November 2009 in hospital were analyzed retrospectively.Results (1) In the study. infection was the most common cause of pleural effusion. There were 76 cases caused by suppuration (43. 9% ) , 41 cases caused by mycoplasma (23.7%) , 26 cases by tubercul ous - empyema ( 15.0% ) . 2 cases caused by distomapul monala ( 1 . 2% ) . Non - infection cause included 28 cases : 6 cases caused by malignant tumor ( two cases of neuroblastoma , one case of mediastinal tumo, one case of breast cancer. two cases of leukemia) , four cases of congenital chylothorax. one case of nephrotic syndrome, seventeen cases of trauma. ( 2) A total of 69 cases underwent thoracentesis : 64 cases showed exudates( 11 cases of bloody) . and 5 cases showed transudates. (3)There were 26 positive cases in the cultured pleural fluids of 69 cases,with Mycoplasma pneumoniae in 8 cases , Klebsiella pneumoniae in 3 cases , Staphylococcus aureus in 2 cases , G + cocci in 5 cases , fungi in 2 cases . Pseudomonas aeruginosa in 3 cases, acid -fast bacilli in 2 cases, fresh acid from the hair Pseudomonas bacteria in 1 case. (4) Causes of different ages were different. In under - 3 - year group, suppuration was the main cause,which showed statistical difference compared with that in over -3 - year group. In under - 7 - year group, the cause of tuberculous empyema showed statistical difference compared with that in over - 7 - year group. In under - 3 - year group, the cause of mycoplasma showed statistical difference compared with that in over - 3 - year group.Conclusion ( 1 ) In the children, infection is the most common cause of pleural effusion. Suppuration, mycoplasma and tuberculous empyema were the main infective causes , folluwed by trauma, cancer and others. ( 2 ) Its clinical features are different from adults , mainly