Accumulation Of Chylous Fluid Research Articles

Tuberculous Dactilitis in Young Male, a Rare Case

Introduction : Chylothorax is an uncommon medical condition caused by the accumulation of chylous fluid in the pleural space. Chylothorax has no predilection for sex or age. The prevalence after various cardiothoracic surgeries is 0.2% to 1%. Mortality and morbidity rates are around 10%. Respiratory distress may occur due to compression of the lung by the accumulated fluid. Management and approaches to treating the condition require multidisciplinary therapy, starting from non-pharmacological, pharmacological, to interventional management. Case Report : A 57-year-old Man patient was referred to the emergency room with chief complaint of shortness of breath. Reduced breathing sound on both lung fields. No previous history of cancer or thoracic surgery were found. X-ray examination had found bilateral pleural effusion. Thoracocentesis and pleural fluid analysis was performed with total of 6800 cc serosanguinous, whitish fluid was extracted from both of the lung. The patient was diagnosed with chylothorax. Lymphangiography and embolization was performed on the leak on left thoracic duct (T10) from right lymph node. Antibiotic was also given to treat the community acquired pneumonia that could be one of the possible etiology on this patient. Dietary modification with low fat diet and Ocreotide was also given to this patient as one of the treatment modalities. Discussion : The diagnosis of Chylothorax on this patient was established based on pleural fluid analysis and evidenced by lymphangiography examination by the presence of a leak in the thoracic lymphatic duct. Various modalities to diagnose this condition have been carried out with inconclusive results. Non-pharmacological, pharmacological and radiological interventions with embolization through lymphangiography are proven to be able to stop leaks and reduce symptoms in this patient. Conclusion : Chyle leak to the pleural space may compress the lung and cause respiratory distress. Combinaton of thoracocentesis, embolization of the leakage, dietary intake modification and administration of ocreotide may help prevent further chylous fluid accumulation.

Chylopericardium causing cardiac tamponade in a patient with lymphangioleiomyomatosis

Background: Chylopericardium is a rare entity characterized by the accumulation of chylous fluid in the pericardial cavity. Lymphangioleiomyomatosis (LAM) is a rare, progressive systemic disease with prominent features of lung cysts, abdominal tumors, and the development of chylous effusions, usually in the thorax and/or abdomen. Chylopericardium in association with LAM is exceedingly rare, with only a few cases reported in the literature. Case Presentation: We report a case of a 61-year-old woman with chronic dyspnea and bilateral cystic lung disease who presented with a 1-week history of acutely worsening dyspnea. At presentation, she was tachycardiac and hypoxemic, an electrocardiogram detected sinus tachycardia, and a chest radiograph was indeterminate for a small right apical pneumothorax or an apical bulla. An urgent echocardiogram revealed a large pericardial effusion with features of cardiac tamponade, necessitating urgent pericardiocentesis. Analysis of the pericardial fluid confirmed the presence of chylopericardium and a diagnosis of LAM was made. Oral Sirolimus was started and at 1 year of follow-up, the patient has successfully avoided repeat pericardiocentesis. Conclusion: This case describes a rare presentation of a rare disease and suggests that treatment with sirolimus may potentially be effective in reducing the accumulation of chylopericardium in LAM.

New application of direct lymphangiography in the diagnosis and treatment of chylothorax after lung cancer surgery: a case series.

Chylothorax is caused by accumulation of chylous fluid in the thoracic cavity following injury to the thoracic duct or its tributaries. It is a rare but relatively severe complication of lung cancer surgery, especially after lung resection and mediastinal lymph node dissection. If chylothorax is not treated promptly and effectively, it may result in relatively high mortality rate. Although the majority of patients with chylothorax secondary to lung cancer surgery can be treated with conservative measures, there are still some patients who fail to respond to conservative treatment or suffer from recurrent episodes. This study aims to explore the causes of postoperative chylothorax and how targeted treatment can help achieve better outcomes. Four cases of chylothorax secondary to lung cancer surgery are reported in which patients underwent direct lymphangiography (DLG) after failed conservative treatment. Thoracic duct obstruction was found in all patients on DLG, as well as dilated intrathoracic part of the thoracic duct. Thoracic duct reconstruction was performed to successfully treat 3 of the 4 patients. DLG is of great value in the diagnosis of chylothorax secondary to lung cancer surgery, for which thoracic duct reconstruction proves to be an effective procedure. DLG provides a new objective basis for the diagnosis and treatment of chylothorax. It is our best wish to help more patients with chylothorax secondary to lung cancer surgery.

Invasion of the thoracic duct by postlaryngectomy stomal recurrence: a case report

BackgroundPostlaryngectomy stomal recurrence can infiltrate the adjacent tissues of tracheal stoma. However, to the best of our knowledge, there is no report about postlaryngectomy stomal recurrence invading the thoracic duct with intra-mass accumulation of chylous fluid.Case presentationOur patient was a 52-year-old Han man who presented with a cystic-solid mass on the left side of the tracheal stoma after total laryngectomy. A diagnosis of postlaryngectomy stomal recurrence was confirmed by fine-needle aspiration and surgical dissection of the parastomal mass.ConclusionsIn the case of parastomal masses in a total laryngectomized patient, the rare differential diagnosis of postlaryngectomy stomal recurrence invading the thoracic duct with intra-mass accumulation of chylous fluid should be considered a possibility.

Chylothorax after Lung Cancer Surgery: A Key Factor Influencing Prognosis and Quality of Life.

Chylothorax is caused by the accumulation of chylous fluid in the pleural cavity due to the injury of the thoracic duct or its tributaries. Chylothorax following lung cancer surgery, especially pulmonary resection and mediastinal lymph node dissection, is a raw potential postoperative complication as previously reported. Chylothorax might lead to a high mortality rate if not addressed in a timely fashion. This article reviews the anatomy of the thoracic duct, risk factors of postoperative chylothorax, diagnoses and management with chylothorax, and intraoperative prevention of chylothorax. With the development of researches on postoperative chylothorax, more effective treatment and prevention measures need to be proposed to better solve this clinical problem.

Idiopathic Chylopericardium: A case Report and Breif Review of Literature

Chylopericardium is the accumulation of chylous fluid in the pericardial space. Many etiologies can be found and the treatment depends on the etiology and remains unclear. This rare entity needs some tests to determine its causes. Diagnosis is based on many tools; the pericardial biopsy puncture and lymphoscintigraphy are the most important ones. The treatment requires low fat diet, lipid lowering therapy and surgery in some cases. We here report the first case in the IBN ROCHD university hospital’s Cardiology department of Casablanca, Morocco. It deals with a 32-year-old patient who consulted for dyspnea exacerbation for 18 months, becoming at rest. Chest X-ray and echocardiography were performed discovering pericardial effusion. Pericardiocentesis was performed to confirm the nature of liquid and lymphoscintigraphy showed no abnormal communication between the thoracic duct and pericardium.

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.

Idiopathic chylothorax in geriatrics: the oldest case report so far

Abstract Chylothorax is a rare condition characterized by accumulation of chylous fluid in the pleural space resulting in impaired ductus thoracic integrity. It can be an outcome of a traumatic process, although there are a few non-traumatic and/or idiopathic cases in current literature. In this article, we present the oldest case report so for, who is an 87-year-old woman complaining of acute respiratory distress symptoms with pleural effusion having no trauma history. The patient was analyzed for the disease etiology strenuously. Thoracentesis was performed together with imaging modalities and detailed systemic laboratory tests. Non-surgical treatment was successful as the outcome.

O14-5 - Constrictive Pericarditis after Repeated Accumulation of Pericardial Effusion due to Long-term Chylopericardium

Primary chylopericardium is a rare disease characterized by the accumulation of chylous fluid containing high triglyceride in the pericardial cavity without a specific cause. We report a case of severe constrictive pericarditis due to 9-year history of primary chylopericardium and surgical ligation of the thoracic duct and pericardial window creation. A 24-year old woman diagnosed as primary chyropericardium, was admitted to our hospital for further treatment of heart failure. She had undergone ligation of the thoracic duct and the creation of a pericardial window. She complained of exertional dyspnea and physical examination revealed elevated jugular venous pressure. Chest X-ray showed a normal cardiac silhouette with extensive transudative pleural effusion. Echocardiogram showed severe mitral regurgitation which was slightly observed before surgery, a few pericardial effusion. Left and right ventricular simultaneous pressure recordings revealed equilibration of both ventricular diastolic pressures and a dip-and-plateau configuration. A CT scan demonstrated the thickened pericardium. Based on these findings, she was diagnosed as constrictive pericarditis and severe mitral regurgitation probably due to worsening mitral annular disjunction caused by the tight pericardium adhesion to the myocardium. During surgery, extensive tissue adhesions were observed from pericardium to epicardium. Histological examination revealed fibro-adipose pericardium with chronic inflammation and myxoid degeneration. She successfully underwent pericardiectomy and mitral valve plasty, and discharged home with greatly improved symptoms.

Intestinal torsion causing chylous ascites: a rare occurrence

Intestinal torsion and chylous ascites are very rarely associated. We present the case of a 19-year-old man who presented with acute abdomen. Computed tomography of his abdomen showed features suggestive of intestinal torsion. Chylous ascites was incidentally discovered on exploratory laparotomy. The chylous fluid was drained, the small bowel detorted and the coloduodenal adhesion band taken down. The patient's retroperitoneum was explored to exclude occult masses and malformations of the lymphatics. Post surgery, the patient recovered uneventfully. In this case, we postulate that intestinal malrotation had caused the obstruction of the lymphatic flow from the mesenteric lymphatic channels, leading to the exudation of chyle, which then resulted in the accumulation of chylous fluid in the peritoneal cavity. It is important to exclude the more common causes of atraumatic chylous ascites, such as enlarged retroperitoneal lymph nodes or lymphatic malformations.

Bilateral Chylothorax After Severe Vomiting in a Child

In the etiology of chylothorax, traumas and malignancies are the first two leading causes. Today in pediatric patients, the most common cause of chylothorax includes the complications secondary to cardiothoracic operations. Bilateral chylothorax is rarely observed after severe vomiting leading to increase in intrathoracic pressure. In idiopathic chylothorax, bilateral localization is dominant. A 9-year-old girl who presented to our emergency department with the complaints of dyspnea and back pain following severe vomiting received a diagnosis of bilateral chylothorax. The patient was treated with the insertion of a bilateral chest tube, and pleurodesis was performed in left hemithorax. Examination did not reveal a pathology to this condition, except the vomiting observed 2 days previously after the meal.

Chylopericardium Secondary to Lymphangiomyoma - A case report -

Chylopericardium is a rare disease entity characterized by the accumulation of chylous fluid in the pericardial sac. It usually arises from mediastinal neoplasms, thrombosis of the subclavian vein, tuberculosis, nonsurgical trauma, thoracic or cardiac surgery. The spectrum of symptoms for chylopericardium varies from an incidental finding of cardiomegaly to dyspnea, upper abdominal discomfort, cough, chest pain, palpitation, fatigue. However, most of the patients are asymptomatic. The main purpose of treatment of chylopericardium is the prevention of cardiac tamponade and prevention of metabolic, nutritional, and immunological compromise due to chyle leak. Here, we report a case of chylopercardium secondary to lymphangiomyoma with review of the literature.

Infertility and chylous ascites? A case report

IntroductionChylous ascites is defined by an accumulation of chylous fluid in the peritoneal cavity and it clinically appears as a milky fluid in which laboratory examination reveals triglycerides, cholesterol, and sometimes chylomicrons and lymphocytes. Presentation of caseWe report the first case of primary chylous ascites observed during laparoscopy for unexplained secondary infertility. DiscussionChylous ascites has never been linked to fertility but bathes all internal reproductive organs surfaces and is considered a communication mean between ovaries. ConclusionDespite a lack of evidence, the question of peritoneal fluid role remains in infertility.

Congenital Idiopathic Chylothorax In A Jamaican Neonate: Management Challenges

Congenital idiopathic chylothorax is the accumulation of chylous fluid in the pleural space. Typically occurs in the late third trimester and possible explanations are malformation and leakage from the thoracic duct. We report an index case in a Jamaican neonate diagnosed with polyhydramnios and bilateral pleural effusions by routine sonography at 34 weeks gestational age. Antenatal diagnostic work up done aimed to exclude hydrops fetalis and its numerous aetiologies. We highlight our limitations.At birth elective mechanical ventilation was essential and bilateral thoracostomy tubes placed were both diagnostic and therapeutic. The infant received a specialized diet exclusively for 8 weeks and regular feeds were tolerated at 8 weeks. The rarity of this condition, diagnostic limitations such as ready availability of karyotyping, limited facilities for antenatal intervention may present surmountable management challenges.

Postoperative Chylous Ascites: Diagnosis and Treatment

The accumulation of chylous fluid in the abdominal cavity is an infrequent yet alarming complication in abdominal surgery. Excessive lymphatic leakage is occasionally encountered in the course of operations at the base of the mesentery or retroperitoneum. A source can usually be identified and the leak controlled at the time of laparotomy by suture or clip. In the region of presumed leakage the importance of these efforts is reinforced by the are patient in whom such leakage persists, creating problems in recognition and management postoperatively. The development of this complication in a patient undergoing total abdominal colectomy and left-sided hepatic lobectomy prompted a review of our experience and a literature review. We report four cases of postoperative chylous ascites seen over 5 years. The fluid accumulation followed operations on the abdominal aorta (two patients) and on the colon and liver (one patient) and after a mesocaval shunt procedure (one patient). Two patients responded to low-fat, medium-chain triglyceride diets; one patient required peritoneovenous shunting; and one patient died of progressive nutritional deterioration. We review the recognition and management of chylous ascites based on our experience and that reported elsewhere.