Spontaneous chylothorax

Transient spontaneous chylothorax presented with neck pain and swelling in a patient with latent TB: Case report

The aim of this case report is to raise awareness about self-limited spontaneous chylothorax. Extensive workup for small nontraumatic chylothorax may not be justified.

Isolated thoracic duct injury from blunt force trauma

Isolated thoracic duct injury is an uncommon clinical event and is rare in the setting of trauma. We describe a case of an isolated thoracic duct injury resulting in the development of bilateral chylothorax following a motor vehicle collision in the absence of any other definable injury. We outline the initial patient presentation and diagnosis. After failing a trial of conservative management the patient underwent lymphangiography followed by thoracic duct ligation with pleurodesis. This case highlights the importance of recognizing thoracic duct injury following trauma.

[Chylothorax]

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.

Chylothorax after childbirth

We report a case of chylothorax which appeared in a mother after childbirth. Disruption of the thoracic duct occurred with the high intrathoracic pressures generated by the Valsalva maneuver used by the patient during labor to "push." No evidence of other trauma or malignancy were found and the patient did well after use of total parenteral nutrition, thoracotomy with thoracic duct ligation, and pleurodesis.

Chylothorax and tuberculosis

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Chylothorax. Clinical experience in nine cases

Clinical experience in nine cases of chylothorax is presented. In five cases the cause was iatrogenic, in two cases idiopathic and in two cases the chylothorax was secondary to an advanced malignant disease. Iatrogenic chylothorax occurred after mediastinoscopy, thoracic sympathectomy, pneumonectomy, resection of an aneurysm of the thoracic aorta and closure of a patent ductus arteriosus. Only one of these patients needed an operative closure of the thoracic duct. In one of the two cases of a neoplastic origin the chylothorax was caused by a malignant mesothelioma and thoracic duct ligation was needed while in the other case it was due to an inoperable pancreatic carcinoma and was treated by thoracocentesis. In one of the idiopathic cases supradiaphragmatic ligation of the thoracic duct was necessary. It is concluded that in most iatrogenic or traumatic cases chylothorax can be cured by conservative therapy (diet, thoracocentesis); in other cases the operative therapy should be adjusted to the primary disease, and the ligation of the thoracic duct should be performed at a level where it is able to prevent the chylous leak without unnecessarily interfering with the collateral lymphatic circulation. Abundant and prolonged chylous leakage should be always treated operatively to prevent disastrous nutritional and immunological deficiencies.

Management of nontraumatic chylothorax

Twenty-two patients with chylothorax have been treated at the National Institutes of Health since 1955. In 9 of these patients, the condition resulted from an antecedent operation and in 13, it occurred without a history of prior operation (nontraumatic). All 6 of the patients with tumors in whom nontraumatic chylothorax developed had a lymphoma. Four of these 6 also had a chylous ascites, while 6 of the 7 patients without tumors had an associated chylous ascites. Only 3 of the 13 patients with nontraumatic chylothorax responded to nonoperative therapy alone with stabilization of the pleural effusions. A single patient with systemic lupus erythematosus responded to steroid therapy. In contrast, 3 of 4 patients who underwent thoracotomy for nontraumatic chylothorax had permanent relief of their chylous pleural effusions. In the absence of medically treatable disease, thoracotomy with ligation of the thoracic duct and/or pleurectomy or pleurodesis can provide substantial palliation for patients with nontraumatic chylothorax, even when a discrete source of lymph leakage cannot be localized or ascites is present. Early surgical therapy of nontraumatic chylothorax is advocated in such circumstances.

Chylothorax as a manifestation of rheumatic mitral stenosis: its postoperative management with a diet of medium-chain triglycerides

Chylothorax occurred as a manifestation of severe congestive heart failure resulting from rheumatic mitral stenosis. Following replacement of the mitral valve, chylothorax recurred and was treated by thoracocentesis initially and then resolved during six months of therapy with a diet of medium-chain triglycerides. Ultimately, the patient resumed a regular diet with no further accumulation of pleural fluid.

Pleural effusion in Wilms' tumor

The association of pleural effusion and Wilms' tumor is uncommon. We report three patients who developed pleural effusion as a result of different mechanisms, all of which were related to Wilms' tumor or to its treatment.