Bilateral chylothorax; an unusual complication of radical neck dissection with recovery

Bilateral chylothorax following neck dissection on a child—Diagnosis and management in resource-limited settings: a case report

Bilateral chylothorax is a rare complication following neck dissection, with fewer than thirty cases being reported over the last century. A serious life-threatening condition mostly encountered during thoracic procedures and dissections. In our case, conservative management resulted in complete resolution. We report a case of a 4-year-old child who underwent deep neck dissection due to recurrent hemangioma. She developed bilateral chylothorax and a conservative approach led to complete resolution.

Anatomical variations in distal portion of the thoracic duct-A systematic review

The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical dissections and surgical or radiological procedures for better knowledge of the interindividual variations through a systematic review. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search terms included "TD," "Jugular Vein," "Subclavian Vein," or "Cervical," and the protocol used is reported herein. These search results yielded 20 qualitative review articles out of the 275 articles consulted. We collected all the important data from these 20 articles with 1,352 TD analyzed by varying sources in our search. Regarding the characteristics of the studies and the anatomy of the TD, the results were heterogeneous. The TD most commonly terminates in the internal jugular vein in 54.05% of cases (95% confidence interval [CI]: 54.03; 54.07), in the jugular-venous angle in 25.79% (95% CI: 25.77; 25.81), and in the subclavian vein in 8.16% of cases (95% CI: 8.14;8.18). Other terminations were found in 12% of cases. This systematic review provided an overview of the variations in the distal portion of the TD. This study can be helpful for surgeons in selecting the most appropriate methods to achieve successful surgical results and avoid complications, such as chylothorax; it also offers detailed information on the cervical termination of the TD in new diagnostic and therapeutic methods involving the TD. Clin. Anat. 32:99-107, 2019. © 2019 Wiley Periodicals, Inc.

Chylothorax in thyroid surgery: a very rare case and systematic review of the literature

Background

Chylothorax is a very rare but major complication in thyroid surgery and should be apparent to clinicians in this field.

Case presentation

We report a case with chylothrax after thyroid surgery in our department that drew our attention.

Methods

Systematic review of the literature to evaluate the incidence and the contributing factors of chylothorax after thyroid surgery. Database (PubMed) and hand searches to identify patients with thyroid surgery and postoperative chylothorax. Keywords included chylothorax, thyroidectomy, thyroid surgery and complications. Two independent reviewers screened studies against inclusion and exclusion criteria. Patient characteristics, risk factors, symptoms, treatments and etiopathogenesis were investigated.

Results

We identified 13 articles in the literature describing 19 patients with chylothorax after thyroidectomy and described our own case. Ninety percent of the patients underwent thyroidectomy for thyroid cancer. Sixteen patients (80 %) underwent thyroidectomy with at least a left lateral neck dissection, 2 patients (10 %) underwent thyroidectomy with sternotomy, and in the remaining 2 patients (10 %), thyroidectomy with lateral neck dissection on both sides was performed with partial sternotomy. Our calculated incidence for chylothorax with total thyroidectomy and neck dissection was 1.85 %; for a thoracic approach the calculated incidence was 7.3 %.

Conclusions

There are no reports of chylothorax after thyroidectomy without at least a left lateral neck dissection due to advanced thyroid cancer and/or sternotomy due to the thyroid size. The extension of thyroid surgery seems to be the main risk factor in developing chylothorax either through direct surgical trauma or through increased intraductal pressure after thoracic duct ligation. An early diagnosis of chylothorax may avoid severe metabolic or cardiopulmonary complications.

Bilateral Chylothorax after Neck Dissection

Chylous fistula is a well-recognized complication of neck dissection, occurring in 1% to 2% of cases. 1 Cardiopulmonary complications, on the other hand, are rare. Bilateral chylothorax is an extremely rare occurrence following neck dissection. Severe respiratory, metabolic, and immunologic derangements can occur secondary to chylothorax. We report a case of bilateral chylothorax after neck dissection and cervical thoracic duct ligation.

Bilateral Chylothorax Following Neck Dissection: Case Report & Review of Literature

Bilateral Chylothorax following neck dissection is an extremely rare complication. We report a case of bilateral chylothorax detected after neck dissection for carcinoma of lower alveolus. A 61 year Indian female underwent wide excision with segmental mandibulectomy with comprehensive neck dissection for carcinoma of left lower alveolus clinically staged T4N0. Evaluated for dyspnea in post operative period, she was found to have bilateral chylothorax that was managed conservatively. This case report presents potentially life threatening complication following neck dissection that often responds to non surgical management.

Spilt Milk

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

Bilateral chylothorax following left supraclavicular lymph node dissection for breast cancer: one case report and literature review

Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even rarer. However, both are potentially serious and sometimes life-threatening, especially those that are associated with left neck dissection for head and neck neoplasms. We report one case of bilateral chylothorax following left supraclavicular dissection for breast cancer. This case was treated successfully with a new conservative management approach.

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

Chylothorax is a rare complication of neck dissection. We report three cases of chylothorax after neck dissections for thyroid carcinoma and attribute this relatively high incidence to the assumption that most patients are asymptomatic. Thus, conventional chest X-ray or ultrasonography in the early postoperative period may be warranted to exclude asymptomatic chylothorax, especially if the thoracic duct is injured and ligated during the operation. We suggest that for chylothorax induced by ligation of the thoracic duct, which may be transient and resolve quickly, short-term thoracic drainage is enough.

Three cases of bilateral chylothorax developing after neck dissection

Only 16 cases of bilateral chylothorax following neck dissection have been reported within 10 decades. In this paper, three cases of bilateral chylothorax which developed after neck dissection are reported. In all cases, conservative treatment resulted in resolution of the condition. Diagnosis may be delayed in those who are on total parenteral nutrition, and therefore particular attention should be paid to those patients. It may be difficult to treat cases of chylothorax that develop following neck dissection performed after radiotherapy.

Bilateral chylothorax following radical neck dissection

Bilateral chylothorax as a complication of radical neck dissection is extremely rare, but it is potentially serious and sometimes fatal. We found only 14 cases reported in the English literature. Here, we report a case of bilateral chylothorax following right modified and left radical neck dissections that was successfully treated with conservative management.

Management of Persistent Chylothorax

The aggressive management of persistent chylothorax is necessary for avoidance of significant morbidity and possible mortality. The failure of TPN and chest tubes to rapidly control a chylothorax should lead to consideration of thoracic duct ligation.

Bilateral chylothorax following thoracic duct ligation: case report and review of the literature

Bilateral chylothorax following thoracic duct injury is a rare occurrence. Since 1907 there have been only six reports in the literature of this potentially serious complication. We report a case of bilateral chylothorax following ligation of the cervical thoracic duct during a left subclavian to carotid artery transposition.

Bilateral chylothorax following neck dissection

BACKGROUND

Bilateral chylothorax, as a complication of neck dissection, is extremely rare, and was first described in 1907. Ten cases are reported in the literature.

METHODS

This presentation illustrates an additional case of bilateral chylothorax occurring after neck dissection. Anatomic and physiologic considerations are presented and possible mechanisms of pathogenesis are discussed.

RESULTS

Chylothorax has two major complications: respiratory and metabolic. The modern concepts of treatment are summarized.

CONCLUSIONS

After neck dissection, the clinician should suspect chylothorax if the patient had respiratory embarrassment and an abnormal chest x-ray postoperatively.

Right chylothorax following left radical neck dissection

The development of a right chylothorax following left radical neck dissection for melanoma is reported. Chylothorax following neck dissection is extremely rare, with only 12 cases documented in the literature. Seven of these were bilateral and three were unilateral (all left-sided); unilateral right chylothorax after neck dissection has not been reported previously. Chylothorax is more common after intrathoracic surgery or trauma. Regardless of its cause, the condition is potentially serious and sometimes fatal. Our patient was successfully managed without further surgery. The aetiology and management of chylothorax following neck dissection are discussed.

Dyspnea resulting from accumulation of pleural effusion after radical neck dissection. A case report

The patient became dyspneic 3 days after radical neck dissection on the left side. A chest radiography showed bilateral pleural effusion.During the operation, a lymphatic leak was noted. In this case, the factor of an associated perforation of the pleural had not been demonstrated. Fresh frozen plasma was administered and positive end-expiratory pressure was applied. The patient had no residual pulmonary sequelae.

Bilateral chylothorax from radical neck dissection

Bilateral chylothorax is a rare complication occurring after head and neck surgery, with only six cases reported. The diagnosis is not difficult if a high index of suspicion is held. Early recognition and treatment prevent the devastating metabolic effects of excessive chyle loss and reduce the respiratory restriction that can progress to fatal anoxia. Dietary management with medium-chain triglycerides is essential to successful outcome. Repeated invasive therapy should be minimized.

Bilateral chylothorax complicating radical neck dissection: report of a case with no concurrent external chylous leakage

Bilateral chylothorax as a complication of radical neck dissection is extremely rare. Six cases are reported in the English literature. All of these patients' cases were associated with a concurrent external chylous fistula, as evidenced by the appearance of a milky fluid confirmed to be chyle by chemical determination. Chyle had also been noted to leak during the operation. This presentation illustrates an additional case of bilateral chylothorax occurring after radical neck dissection, and the first case, to our knowledge, with no concurrent external lymph leakage. Anatomic and physiologic considerations are presented and possible mechanisms of pathogenesis are discussed. Chylothorax has two major complications--respiratory and metabolic. A short summary of the modern concepts of treatment is presented.

Surgery in cancer of the mouth

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