Coincident bilateral chylothorax and chylous ascites: Review of the literature and case report

Abstract

T HE problems of chylothorax and chyIous ascites, whether of traumatic or nontraumatic origin, are unusual in the lives of most physicians. Apparently, however, these conditions are increasing in frequency due to automobiIe injuries, on the one hand, and to new surgica1 operations in the region of the thoracic duct, on the other hand. In recent decades various investigators have been abIe to describe and cIassify various types and etiologies of these manifestations of disease. Others have made significant contributions in the therapy of these diffrcuIt probIems. Some cases, however, remain df obscure origin and are resistant to modern methods of treatment. The foIlowing is a report of such a case. It was referred to by Loe in his discussion of Brewer’s paper, but has not been reported in detai1 before [I]. The onIy other remarkabIe item in the history was the presence of an edematous Ieft hand and forearm since birth which was otherwise normal in deveIopment and function. He was admitted to the King County HospitaI on December 14, 1954. Physical examination reveaIed that the bIood pressure was 125/85 mm. Hg; puIse, 80; respirations, 20: and temperature, 98.6%. The head, eyes, ears, nose and throat were negative for abnormaIities. The thyroid was norma in size and consistency and there were no masses or nodes. The chest was barreI-shaped. There was duIIness to percussion posteriorIy on the right and to the IeveI of the fifth rib, and less high on the Ieft. Breath sounds in these areas were very distant. Examination of the heart reveaIed no abnormalities. The abdomen was markedIy protuberant, with diastasis recti and fluid wave present. No organs or masses were noted, and there was no tenderness. Recta1 examination was negative and the genitalia were normal.