Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography

BACKGROUND This study presents an evaluation of the computed tomography lymphangio-graphy(CTL)features of lymphatic plastic bronchitis(PB)and primary chylotho-rax to improve the diagnostic accuracy for these two diseases.AIM To improve the diagnosis of lymphatic PB or primary chylothorax,a retrospective analysis of the clinical features and CTL characteristics of 71 patients diagnosed with lymphatic PB or primary chylothorax was performed.METHODS The clinical and CTL data of 71 patients(20 with lymphatic PB,41 with primary chylothorax,and 10 with lymphatic PB with primary chylothorax)were collected retrospectively.CTL was performed in all patients.The clinical manifestations,CTL findings,and conventional chest CT findings of the three groups of patients were compared.The chi-square test or Fisher's exact test was used to compare the differences among the three groups.A difference was considered to be statistically significant when P<0.05.RESULTS(1)The percentages of abnormal contrast medium deposits on CTL in the three groups were as follows:Thoracic duct outlet in 14(70.0%),33(80.5%)and 8(80.0%)patients;peritracheal region in 18(90.0%),15(36.6%)and 8(80.0%)patients;pleura in 6(30.0%),33(80.5%)and 9(90.0%)patients;pericardium in 6(30.0%),6(14.6%)and 4(40.0%)patients;and hilum in 16(80.0%),11(26.8%)and 7(70.0%)patients;and(2)the abnormalities on conven-tional chest CT in the three groups were as follows:Ground-glass opacity in 19(95.0%),18(43.9%)and 8(80.0%)patients;atelectasis in 4(20.0%),26(63.4%)and 7(70.0%)patients;interlobular septal thickening in 12(60.0%),11(26.8%)and 3(30.0%)patients;bronchovascular bundle thickening in 14(70.0%),6(14.6%)and 4(40.0%)patients;localized mediastinal changes in 14(70.0%),14(34.1%),and 7(70.0%)patients;diffuse mediastinal changes in 6(30.0%),5(12.2%),and 3(30.0%)patients;cystic lesions in the axilla in 2(10.0%),6(14.6%),and 2(20.0%)patients;and cystic lesions in the chest wall in 0(0%),2(4.9%),and 2(4.9%)patients.CONCLUSION CTL is well suited to clarify the characteristics of lymphatic PB and primary chylothorax.This method is an excellent tool for diagnosing these two diseases.

Primary membranous nephrotic syndrome with chylothorax as first presentation:A case report and literature review

BACKGROUND Primary membranous nephrotic syndrome with chylothorax as the first manifestation is an unusual condition.To date,only a few cases have been reported in clinical practice.CASE SUMMARY The clinical data of a 48-year-old man with primary nephrotic syndrome combined with chylothorax admitted to the Department of Respiratory and Critical Care Medicine of Shaanxi Provincial People's Hospital were retrospec-tively analysed.The patient was admitted to the hospital for 12 d due to shortness of breath.Imaging showed pleural effusion,laboratory tests confirmed true chylothorax,and renal biopsy revealed membranous nephropathy.After primary disease treatment and early active symptom treatment,the prognosis of the patient was good.This case suggests that chylothorax is a rare complication of primary membranous nephrotic syndrome in adults,and early lymphan-giography and renal biopsy can assist in the diagnosis when there are no contrain-dications.CONCLUSION Primary membranous nephrotic syndrome combined with chylothorax is rare in clinical practice.We report a relevant case to provide case information for clinicians and to improve diagnosis and treatment.

Congenital Chylothorax Treated with Oral Sildenafil—Case Report from Nigeria and Review of Literature

Congenital chylothorax, a condition in which chyle accumulates in the pleural cavity, is extremely rare. The reported incidence is 1 in 24,000 births. Medical treatment using octreotide as well as chemical and surgical pleurodesis has been reported, but also few reports on the successful use of Sildenafil exists. We herein report a case of congenital chylothorax referred to our Hospital at 7 days-old. Sildenafil was introduced on day 6 post intubation. Before the introduction of sildenafil, the peak total daily drainage was 106 ml/kg/day (340 mls/day), and after sildenafil was introduced, the total daily drainage dropped progressively to 10 ml/kg/day by day 11 post intubation. This case report highlights the successful use of oral Sildenafil for treatment of congenital chylothorax and also peculiarities of management related to a resource- constrained developing country setting in Africa.

THE TREATMENT OF CHYLOTHORAX

Objectives.To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons. Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963～1997 were retrospectively analyzed. Results.Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. Conclusion.Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.d treatment of chylothorax caused by various reasons. [WT5”BX] Method.The treatment results of 31 cases of chylothorax in PUMC hospital from 1963～1997 were retrospectively analyzed. [WT5”BX] Results.Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively, 2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured. [WT5”BX] Conclusion.Surgical intervention should be aggressively recommended for the traumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.

Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis

A pleural effusion containing chylomicrons is termed chylothorax and results from leakage of lymph fluid into the pleural cavity.We report on the case of a 59-year-old woman with severe dyspnea due to a large chylothorax.She was known to have liver cirrhosis but no ascites.There was no history of trauma,cardiac function was normal and thorough diagnostic work-up did not reveal any signs of malignancy.In summary,no other etiology of the chylothorax than portal hypertension could be found.Therapy with diuretics as well as parenteral feeding failed to relieve symptoms.After a transjugular intrahepatic portosystemic shunt(TIPS) had successfully been placed,pleural effusion decreased considerably.Eight months later,TIPS revision had to be performed because of stenosis,resulting in remission from chylothorax.This case shows that even in the absence of ascites,chylothorax might be caused by portal hypertension and that TIPS can be an effective treatment option.

Case Report:A case of chylothorax treated curatively with Sapylin, a streptococcus preparation

Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative manage- ment, 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.

Treatment Strategy for Chylothorax after Resection for Lung Cancer—16 Case Report

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

MR Lymphangiography for Focal Disruption of the Thoracic Duct in Chylothorax of an Infant: a Case Report and Literature Review

Chylothorax is a rare cause of pleural effusion in children, and it is usually difficult to identify the location of chyle leakage due to the small size of the thoracic duct in children. Herein we report an infant case with chylothorax whose leakage of the thoracic duct was successfully located by magnetic resonance lymphangiography (MRL) using pre-contrast MR cholangiopancreatography (MRCP) and gadodiamideenhanced spectral presaturation inversion recovery (SPIR) T1-weighted imaging, which demonstrate the imaging method is easy and effective for detecting the focal disruption of the thoracic duct in children with chylothorax and younger than 8 months old.

Blunt traumatic tension chylothorax:Case report and minireview of the literature

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

Chylothorax following posterior low lumbar fusion surgery:A case report

BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery.The etiology,diagnosis,and treatment were analyzed and discussed.CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain.She was diagnosed with L4 degenerative spondylolisthesis,L4/L5 and L5/S1 intervertebral disc herniation and L5 instability,and underwent successful posterior L4-S1 instrumentation and fusion surgery.Unfortunately,thoracic effusion was identified 2 d after operation.The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests.The patient was discharged after 12-d persisting drainage,3-d total parenteral nutrition and fasting,and other supportive treatments.No recurring symptoms were observed within 12 mo follow-up.CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion.Comprehensive diagnosis and treatment of chylothorax are necessary.Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Aim: Chylothorax is a recognized complication after surgery for congenital diaphragmatic hernia (CDH) in a neonate. Management strategies for chylothorax include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. It is important to determine which is the better plan for treatment of chylothorax after repair of CDH. The authors report successful management by use of the MCT diet for a neonate with chylothorax after repair of CDH. Case: A male infant weighing 3.0 kg was delivered by cesarean section at 38 weeks of gestation and intubated immediately after birth. Prenatal ultrasonography had disclosed left-sided posterolateral diaphragmatic hernia. After stabilization, surgery was performed via a left-sided transverse supra-abdominal incision. The unfixed colon, small bowel, stomach, and spleen were reduced from the chest with little difficulty. A hernia sac was not present and the left-sided posterolateral diaphragm showed a defect 3.5 cm × 2.0 cm in width. The child was fed via a nasogastric tube starting on postoperative day 4 and dyspnea disappeared. Plain chest X-ray on postoperative day 7 showed left pleural radioopacity. A specimen of the chest drainage examined on postoperative day 10 was typical of lymph, with a triglyceride level of 328 mg/dl. The chest drainage was dark yellowish, and a medium-chain triglyceride formula was used until postoperative day 30, by which time the effusion has disappeared. Discussion: Chylothorax after repair of CDH may be a transient disorder that will resolve after a period of diminished flow through the thoracic lymphatics.

Intralipid application and massive ligation around the aorta for refractory chylothorax:a case report

A 58 years old male patient underwent esophagectomy for esophageal cancer.Refractory chylothorax happened after operation in spite of different treatment including conservation therapy and thoracic duct ligation.He was enterally administrated 250 mL 30% intralipid before operation.Exploration showed there was a milky leakage from the soft tissue near the anastomotic stoma behind aortic arch where is difficult to handle.We gently mobilized the aorta in the front of the ninth spine and bundled it with its adjacent tissue including azygos vein and thoracic duct with a dacron patch.The leakage ceased rightly and the following recovery went smoothly.

Rupture of the Thoracic Duct as a Result of Injury with Subsequent Development of Bilateral Chylothorax

We present a unique case of a 49-year-old woman presenting with a bilateral chylothorax sustained after minor injury. This condition developed secondarily to minor neck injury which resulted in left side cervical swelling. First treatment was conservative. Surgical intervention was nevertheless necessary to remove a cervical cyst contiguous with the thoracic duct.

Lymphoscintigraphy Using Dynamic Imaging and SPECT/CT in Chylothorax

Lymphoscintigraphy readily provides confirmation of chylothorax but not detailed localization of the leakage site. A 77-year-old woman developed traumatic chylothorax and underwent lymphoscintigraphy with radiolabeled albumin to identify the site of lymph leakage. Dynamic imaging demonstrated appearance of focal activity presumably in the upper mediastinum, followed by spread to the left hemithorax. Subsequently, SPECT/CT showed that the leakage site was located in the left side of the upper mediastinum, and this location was confirmed during video-assisted thoracoscopic surgery. Dynamic imaging demonstrated the site of first appearance of abnormal activity, and SPECT/CT enabled detailed localization of the abnormal activity with anatomic correlation. The combination of dynamic imaging with SPECT/CT appears to be recommendable for lymphoscintigraphic assessment of chylothorax.

Are There Early Clinical Factors to Decide Early Surgical Management for Secondary Chylothorax? A Review of 32 Cases

Background: Chylothorax may be primary (spontaneous) or secondary and more often arising as a postoperative complication of thoracic surgery. It occurs when the thoracic duct or its lymphatic tributaries become blocked or perforated or divided resulting in a chylous pleural effusion. Loss of chyle leads to nutritional deficiencies, dehydration, ionic perturbation and lymphocytes leaks thus increasing the vulnerability for infections and respiratory dysfunction. It is a life-threatening complication increasing the postoperative hospital stay. Management of chylothorax is firstly medical which leads to the cessation of leaks in most of the cases. Surgical treatment by thoracic duct ligation is sometimes necessary after failure of medical treatment. The appropriate time for surgical treatment is a subject of controversy. Methods: Reviewing a series of patients treated between 2000 to 2010 in a single center with the same protocol management, the aim of the study was to identify early clinical variables allowing early surgical treatment in postoperative chylothorax. Results: Thirty-two patients were identified in the study period. There were 21 males (65.6%) and 11 females (34.4%) with a mean age of 55.7 years (range from 9 to 79 years) (Table 1). Twenty-two patients (68.75%) had chylothorax after a surgical intervention, seven patients (21.8%) had chylothorax due to medical causes and three patients (9.3%) after chest trauma. Thirty-eight percent of patients treated conservatively were after lung cancer resection and 35% of patients treated surgically where after esophageal resection. Chylothorax was stopped in 33% of patients after lymphangiography. Cumulative leak per day was 1007 ml/day for operated patients and 397 ml/day for patient treated conservatively. Esophageal resection surgery and the amount of fluid leak were the two factors founded to be associated for the decision of an earlier surgical treatment. Conclusion: Chylothorax arising after esophageal resection with a flow rate of leak of more than 500 ml/day should be proposed to an earlier surgical treatment. Lymphangiography remains a key stone assessment with a double aim diagnostic and therapeutic in chyle leakage.

Congenital Chylothorax: Rapid and Effective Response to Polyvidone Iodine

Introduction: Congenital chylothorax, defined by the presence of chyle in the pleural cavity, is a rare congenital disorder of varying severity. The objective of this study was to report a case of idiopathic congenital chylothorax treated with povidone iodine effectively without side effects after failure of conservative treatment by chest drainage. Case presentation: A term female Newborn was admitted in the neonatal intensive care unit at 16 days of life, for respiratory distress. The Clinical examination objectified a Sliverman score of 3/10 with a pleural effusion syndrome. The chest radiography confirmed the pleural effusion and the analysis of the pleural fluid after aspiration confirmed the chylothorax, with a protein rate of 35 g/l, Triglycerids 37 mg/L, and Leukocytes count was 1140/ml with 90% lymphocytes. A chest drainage was performed on the seventh day but followed by the recurrence of the effusion. The use of 5 ml of 4% povidone iodine in the pleural space as a chemical pleurodesis was performed. The clinical and radiological evolution was favorable after 24 hours without relapse or side effects such as allergic reaction or worsening of the respiratory condition. Thoracic ultrasound was performed after 15 days, having objectified minimal right side effusion measuring 5 mm maximum thickness. Conclusion: Chemical pleurodesis by the polyvidone iodine in the chylothorax appears to be affordable and effective, and needs to be more considerate in the conservative treatment of congenital chylothorax.

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.

一例猫特发性乳糜胸保守疗法与胸导管手术治疗的效果比较

2023年9月19日,一只1岁6个月雄性狸花猫因呼吸急促、胸腔积液转至河南省启点医院就诊。抽吸胸腔积液可见淡粉色、不透明的乳糜。经过血常规、血液生化、血清淀粉样蛋白A(SAA)、X线、心脏超声等检查以及猫心脏疾病快速检测和胸腔积液分析,最终确认为特发性乳糜胸。先采用每日低脂饮食,口服芦丁片以及抽吸胸腔积液的保守疗法,然后选择胸导管结扎术手术治疗。保守治疗后,胸腔积液量仍持续增多;手术治疗后,进行常规对症用药与疼痛管理,胸腔积液量逐渐减少,持续跟进近3个月预后良好。结果说明保守治疗对该病例的疗效不佳,胸导管结扎术是治疗乳糜胸安全有效的方式。从病例术后产生积液的量和持续时间来看,如能合并心包切除术,更能有效缓解疼痛,减少术后并发症,加快恢复。本文为猫特发性乳糜胸的鉴别与诊断以及治疗方式选择提供了参考。

Clinical approach for pulmonary lymphatic disorders

In this editorial,we discuss the clinical implications of the article“Lymphatic plastic bronchitis and primary chylothorax:A study based on computed tomography lymphangiography”published by Li et al.Pulmonary lymphatic disorders involve abnormalities in the lymphatic tissues within the thoracic cavity.Specifically,pulmonary lymphatic perfusion syndrome describes a condition where the flow of lymphatic fluid in the lungs is redirected towards abnormally widened lymphatic vessels.Clinically,individuals with this syn-drome may experience symptoms such as chyloptysis,plastic bronchitis(PB),chylothorax,chylopericardium,and interstitial lung disease.These disorders can be caused by various factors,including PB,chylothorax,and complex lymphatic malformations.Advancements in lymphatic imaging techniques,such as in-tranodal lymphangiography,computed tomography lymphangiography,and dynamic contrast-enhanced magnetic resonance lymphangiography,have enabled the detection of abnormal lymphatic flow.This has enhanced our understanding of the pathophysiology of these conditions.Additionally,innovative minimally invasive treatments,such as thoracic duct embolization,selective embolization of lymphatic channels,and surgical procedures aim to improve clinical condition of patients and address their dietary needs.

食管癌患者术后乳糜胸发生情况及其影响因素

目的探寻可能影响食管癌患者术后发生乳糜胸的因素,旨在降低临床食管癌患者术后乳糜胸发生风险。方法纳入医院2019年1月至2021年12月收治的830例食管癌患者,依据患者术后有无发生乳糜胸进行分组。对比发生组与未发生组基线资料,探寻食管癌患者术后发生乳糜胸的影响因素。结果830例食管癌患者中,术后发生乳糜胸30例,占比3.61%(30/830),将其纳入发生组;术后未发生乳糜胸800例,占比96.39%(800/830),将其纳入未发生组;发生组肿瘤直径(≥5 cm)、肿瘤病灶位置(中上段)、纵膈淋巴结肿大(是)、肿瘤分期(≥Ⅲ期)占比均高于未发生组(P<0.05);经多项logistic回归分析结果显示,肿瘤直径、肿瘤病灶位置、纵膈淋巴结肿大及肿瘤分期均是食管癌术后发生乳糜胸的危险因素(OR>1,P<0.05)。结论肿瘤直径≥5 cm、肿瘤病灶位置处于中上段、纵膈淋巴结肿大及肿瘤分期≥Ⅲ期均是影响食管癌患者术后乳糜胸发生的因素,针对合并上述危险因素患者,临床可制定针对性干预手段,以降低食管癌患者术后乳糜胸发生风险。