Abstract
BackgroundYellow nail syndrome is a rare condition considered secondary to functional anomalies of lymphatic drainage. Yellow nail syndrome is diagnosed through the triad of intrathoracic findings (30% being pleural effusions), nail discoloration, and lymphedema, with any two features sufficient for diagnosis. We report the second case of post-operative yellow nail syndrome.Case presentationAfter coronary artery bypass grafting, our patient presented with chylothorax on post-operative day 13 and yellow toenail discoloration on post-operative day 28, diagnosing yellow nail syndrome. Initial conservative management with pigtail catheter drainage and low-fat diet with medium-chain triglycerides reduced chylous drainage from 350 mL/day on post-operative day 14 to < 100 mL/day on post-operative day 17. However, by post-operative day 18, drainage returned to 350 mL/day that persisted despite attempts to readjust the catheter position, replacement of catheter with chest tube, and transition to total parenteral nutrition and octreotide while nil per os. Lymphangiogram on post-operative day 32 did not identify the thoracic duct or cisterna chyli, precluding embolization. Talc and doxycycline pleurodeses performed on post-operative days 33 and 38, respectively, resolved his chylothorax and nail discoloration.ConclusionsBoth yellow nail syndrome and chylothorax as a complication of coronary artery bypass grafting are rare entities. The proposed mechanism of post-operative chylothorax is iatrogenic injury to thoracic duct or collateral lymphatic vessels. Diagnosing yellow nail syndrome in patients with post-operative chylothorax (through co-existing yellow nail discoloration and/or lymphedema) may suggest predisposition to impaired lymphatic drainage, portending a difficult recovery and potentially indicating need for surgical management.
Highlights
Yellow nail syndrome is a rare condition considered secondary to functional anomalies of lymphatic drainage
By post-operative day 18, drainage returned to 350 mL/day that persisted despite attempts to readjust the catheter position, replacement of catheter with chest tube, and transition to total parenteral nutrition and octreotide while nil per os
Yellow nail syndrome (YNS) is a rare condition of unclear etiology considered secondary to functional anomalies of lymphatic drainage
Summary
Chylothorax as a complication of coronary artery bypass grafting is rare, with the most likely mechanism being iatrogenic injury to the thoracic duct or collateral lymphatic vessels. Authors’ contributions All authors were involved in patient care. All authors participated in manuscript revisions and approved the final manuscript. Ethics approval and consent to participate Not applicable. Consent for publication We have obtained written consent from the patient to publish the medical data in this case report. Author details 1Stanford University School of Medicine, Stanford, CA, USA. Author details 1Stanford University School of Medicine, Stanford, CA, USA. 2Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA. 3Department of Interventional Radiology, Stanford University School of Medicine, Stanford, CA, USA. 4Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. 5Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
