Abstract
BackgroundLymphography with Lipiodol is useful for chylothorax. There were many slight complications, but reports of acute respiratory distress syndrome (ARDS) after lymphography were few.Case presentationA 75-year-old man with esophageal cancer developed chylothorax after esophagectomy. Conservative treatment was ineffective, and he underwent lymphography with 8.5 mL of Lipiodol. He developed a high fever soon after lymphography, followed by severe ARDS requiring artificial respiration 5 days later. He recovered from ARDS but subsequently developed pulmonary fibrosis and was discharged with domiciliary oxygen therapy 3 months later.ConclusionAlthough ARDS is a rare complication of lymphography with Lipiodol, this procedure should be applied carefully in patients with chylothorax.
Highlights
Lymphography with Lipiodol is useful for chylothorax
We report a patient who developed severe acute respiratory distress syndrome (ARDS) after Lipiodol lymphography for chylothorax, with a subsequent complication of pulmonary fibrosis
Goff and Gaensler reported a case of respiratory distress syndrome following lymphangiography and retroperitoneal lymph node dissection [5] in a patient who received 20 ml of ethiodized oil injected into each leg
Summary
Chylothorax is a relatively rare but potentially life-threatening complication after thoracic surgery [1], with a reported incidence of 0.6–3.9% after esophagectomy [1,2,3]. We report a patient who developed severe ARDS after Lipiodol lymphography for chylothorax, with a subsequent complication of pulmonary fibrosis. Despite total parenteral nutrition (TPN), the chylothorax continued, and pleural effusion increased to > 1500 ml/day He underwent lymphography for diagnostic and therapeutic purposes on the ninth postoperative day. The patient developed chills, a fever (39 °C), and hypoxia 2 h after lymphography and was treated with oxygen administration and piperacillin-tazobactam for Lipiodol pulmonary embolism and prevention of secondary pneumonia. His hypoxia improved but intermittent fever continued after 4 days. He was discharged on the 112th day, with domiciliary oxygen therapy for hypoxemia due to pulmonary fibrosis (Fig. 3)
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