Pulmonary Lymphangiectasia Complicating Adult Cardiac Surgery

Abstract

A middle-aged female underwent uneventful mitral valve surgery for rheumatic mitral stenosis. Postoperatively, she developed chylothorax. She was initially managed conservatively with a low-fat and medium-chain triglceride diet, pleural space evacuation, enetric rest, hyperalimentation, and octreotride. On failure of medical management she underwent a lymphagiography, which revealed thoarcic duct agenesis. Surgical re-exploration was planned, which revealed no obvious leaking site. A parietal pleurectomy and ligation of overlying fat and thymic tissue was done. Drain output ceased and patient was asymptomatic at discharge and follow-up. Addition of lymphangiography to medical management in refractory chylothorax is therapeutic and diagnostic. In our patient we could detect the presence of pulmonary lymphangiectasia, which is a rare finding and the cause of chylothorax. If medical management fails aggressive surgical therapy should be considered.