Chylous Fluid Research Articles

Primary Chylopericardium and its Surgical Treatment

1. A case of chylopericardium successfully treated by ligation of the thoracic duct has been reported. Up to 1954 no other case has been reported in the world literature. 2. The diagnosis is easy to establish by chemical examination of the milky fluid aspirated from the pericardium. The etiology is doubtful because in this case the history reveals a definite trauma as well as an inflammatory bronchopulmonary episode. There was no mediastinal tumor as in the somewhat different case reported by Groves-Effler in 1954. 3. A study of normal topographic anatomy does not explain this case as normally the thoracic duct and the pericardium are everywhere separated by the esophagus. One has to admit an anatomical variation several of which have already been reported in the literature. 4. The treatment of chylopericardium is surgical exploration of the situation. It will always be extremely difficult to demonstrate and obliterate the abnormal communication and therefore one has to be satisfied with ligation of the thoracic duct to prevent cardiac tamponade. Local irritation of the pericardium by the chylous fluid may lead to chronic pericardial constriction and thus necessitate ultimate cardiac decortication . To prevent this future complication the surgical treatment of chylopericardium at the acute state has to be an early one.

Chylothorax and chyloperitoneum; report of a case occurring after embolism of left subclavian vein with thoracic duct obstruction.

Chylous fluid is rarely found within the serous cavities. This accumulation of fluid may be caused by obstruction or injury of any portion of the thoracic duct. Although the thoracic duct is usually a single structure that empties into the left subclavian vein, it is variable both in structure and venous termination. It may consist of multiple trunks in the thorax with cross communications; it may have multiple venous terminations in left or right subclavian, internal or external jugular, innominate, vertebral, or azygos veins. There may be communications with iliac or lumbar veins, vena cava inferior, or left renal vein. With complete obstruction of the thoracic duct, intraductal pressure increases and distal lymphatics dilate and rupture, producing chylous effusions if no collateral channels exist. If obstruction occurs slowly, collaterals may develop sufficiently to prevent chylous effusions. Yater 1 studied 24 cases of thoracic duct obstruction from various causes; only three

CHYLOUS ASCITES IN INFANCY

A description of a case of chylous ascites with chylocele unassociated with chylous fluid in any other of the body cavities is described. The literature is reviewed and a summary of four similar cases is presented. The 25 cases in the literature are analyzed in terms of etiology, association of chylocele, roentgenographic findings, treatment and prognosis. It is suggested that all such cases, particularly when they occur in the newborn infant, should be treated with conservative measures, i.e., paracentesis and supportive management, before resort to laparotomy. Studies concerning the absorption of vitamin A are presented which indicate that where defects in fat absorption through lymphatic pathways exist, the use of aqueous dispersions of fat soluble vitamins ensures their absorption into the general circulation.

Chylothorax in a two-week-old infant with spontaneous recovery

Summary A case of chylothorax in a 14-day-old infant is presented. The patient recovered following repeated aspiration of the right pleural cavity, over a period of about two weeks, for relief of recurrent respiratory difficulty. A brief review of the literature dealing with chylothorax is given, and a few observations dealing with the nature of the chylous fluid in relation to dietary intake are cited.

A CASE OF CHYLOTHORAX

Clinical Case History The patient, a woman of 49, complained of shortness of breath on exertion, abdominal discomfort, loss of weight, and gradually increasing weakness over a period of eight months. The chest was found to contain a turbid fluid which, on examination, bore the characteristics of a chylous effusion. For the patient's comfort frequent withdrawal of fluid from both sides of the chest, and latterly from the abdomen, became necessary. During the fourteen weeks throughout which she was under observation in the ward 971 ounces of chylous fluid were removed, making a weekly average of sixty-nine ounces. This weekly figure falls considerably short of what is believed to be the amount of lymph entering the subclavian vein, even allowing that food intake and digestive processes were at a low level. It seemed justifiable to con clude, therefore, that the block in the thoracic duct was only partial?a surmise which was confirmed subsequently at post mortem examination.

Chylothorax and chylous ascites

1. 1. This patient presented progressive involvement of all of the superficial lymph nodes. 2. 2. Obstructive phenomena were present. About 12,000 c.c. of chylous fluid were removed from the chest at various times. 3. 3. At autopsy we found enlarged mediastinal lymph nodes which obstructed the thoracic duct. The spleen was markedly enlarged and presented the appearance of a cross section of a Bologna sausage. 4. 4. The clinical syndrome was confused with Hodgkin's disease. 5. 5. The difficulties in diagnosis are evidenced by the differences in opinion expressed by the pathologists who have examined the specimens.

Cervicothoracic ganglionectomy, trunk resection and ramisectomy by the posterior intrathoracic approach

1. 1. This patient presented progressive involvement of all of the superficial lymph nodes. 2. 2. Obstructive phenomena were present. About 12,000 c.c. of chylous fluid were removed from the chest at various times. 3. 3. At autopsy we found enlarged mediastinal lymph nodes which obstructed the thoracic duct. The spleen was markedly enlarged and presented the appearance of a cross section of a Bologna sausage. 4. 4. The clinical syndrome was confused with Hodgkin's disease. 5. 5. The difficulties in diagnosis are evidenced by the differences in opinion expressed by the pathologists who have examined the specimens.

The irritating local effect of human blood serum or plasma containing chyle obtained soon after meals.

In carrying on work with the intradermal blanching test in scarlet fever rashes we noted that serum or plasma obtained from human beings soon after meals and containing a considerable amount of chylous fluid produced a distinct local irritating effect on the human skin. The irritating action showed itself by a local inflammatory area that appeared on the following day. In some of the tests there was a minute superficial postule, which contained polynuclear leucocytes, but no bacteria. Blood serum or plasma taken from the same individuals before meals and appearing quite clear did not show this irritating local action. Studies are being carried out at the present time to see whether the same holds true for bleeding from animals taken before and after meals.This factor of the irritating quality of chyle-containing plasma and serum will have to be taken into consideration when blood is withdrawn from animals that will be used for injections of human beings. The increasing application of human sera obtained f...