Spontaneous Chylothorax Research Articles

Pleural Effusion following Yoga: A Report of Delayed Spontaneous Chylothorax and a Brief Review of Unusual Cases in the Literature

Chylothorax is a rare condition where the extravasated chyle accumulates into the pleural space. It is most commonly associated with malignancies, infective or inflammatory disorders and iatrogenic causes. Extremely rarely, it could occur spontaneously. We present the case of a healthy 40-year-old woman who presented with acute right shoulder and neck pain associated with shortness of breath and loss of consciousness. This was preceded by a yoga class two weeks prior. Chest imaging showed right pleural effusion, and tapping revealed a milky fluid which was confirmed to be chylothorax. Conservative management failed and the patient was successfully treated with video-assisted thoracoscopic drainage, thoracic duct ligation and mechanical pleurodesis. Chylothorax association with yoga is not reported in the literature.

A Rare Case of Recurrent Dasatinib-Induced Chylothorax Years After Initial Treatment

Background: Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome containing the BCR-ABL protein with deregulated tyrosine kinase activity. Tyrosine kinase inhibitors (TKIs) were developed to target this oncogene. Dasatinib, a TKI, has rarely been associated with spontaneous chylothorax. The majority occur within 1 year of dasatinib initiation and resolve after drug cessation. In contrast, we present a patient with CML on dasatinib therapy for 8 years who developed recurrent unilateral chylothorax even after cessation of dasatinib. Case: A 57-year-old male with a history of CML on dasatinib therapy presented to the hospital for nausea and vomiting. A computed tomographic scan revealed a large right-sided pleural effusion with thoracentesis yielding 1.5 liters of chylous fluid. The patient’s hospital course was complicated by intracranial hemorrhage and subsequent admission to the intensive care unit. Dasatinib was stopped during this time. The patient experienced multiple recurrences of this effusion with significant output via thoracentesis and chest tube despite dietary changes. Lymphangiography was performed but revealed no evidence of thoracic duct leakage. Conclusions: Chylothorax from dasatinib is rare, usually occurs within 1 to 2 years of treatment onset, and resolves with discontinuation. However as supported by this case and others, it may occur as late as 8 years from treatment onset and chylothorax may continually re-accumulate or persist up to 1 year from dasatinib cessation. It is imperative to rule out underlying thoracic duct disruption prior to attributing etiology to dasatinib as a misdiagnosis may result in treatment delays.

Small Chyle Leak Localized on Lymphoscintigraphy with Single-Photon Emission Computed Tomography-Computed Tomography.

Chylothorax refers to the accumulation of triglyceride-rich fluid (chyle) within the pleural space. We described a case of spontaneous chylothorax in an infant. Lymphoscintigraphy was performed with 99 m-Tc sulfur colloid which showed tracer accumulation into thoracic cavity, and single-photon emission computed tomography/CT (SPECT/CT) revealed leak in the thoracic duct at D8 vertebral level as the cause. We, thus, emphasize the role of lymphoscintigraphy with SPECT/CT in identification of cause and guiding the management of chylothorax, especially when surgical treatment is planned.

Letter to Editor regarding "Unusual Presentation of Spontaneous Chylothorax".

How to cite this article: Varghese AR, Jindal A. Letter to Editor regarding "Unusual Presentation of Spontaneous Chylothorax". Indian J Crit Care Med 2022;26(11):1225.

Author's Response to an Unusual Presentation of Spontaneous Chylothorax.

How to cite this article: Kaul A, Fursule A, Shah S. Author's Response to an Unusual Presentation of Spontaneous Chylothorax. Indian J Crit Care Med 2022;26(11):1226.

A Case Series of Spontaneous Chylothorax in Lymphoma

Introduction: Chylothorax is a rare condition originating from lymphatic system damage as an accumulation of chyle in the pleural space. It can be classified into spontaneous or non-traumatic, traumatic, and idiopathic. A spontaneous chylothorax is primarily caused by neoplasm, such as lymphoma.Case Presentation: Herein, we report two cases of chylothorax presenting as massive pleural effusion in two patients of a 23-year-old male with nodular sclerosis type Hodgkin’s lymphoma and a 31-year-old female with metastatic lymphadenopathy of undifferentiated carcinoma from non-Hodgkin’s lymphoma.Conclusion: A spontaneous chylothorax is a rare condition that may lead to a life-threatening event when it is not properly and promptly treated.

THE HIDING HEPATIC HYDROTHORAX

TOPIC: Lung Pathology TYPE: Fellow Case Reports INTRODUCTION: Hepatic Hydrothorax is excessive accumulation of pleural fluid in patients with decompensated liver cirrhosis without pulmonary or cardiac disease. Radioisotope diagnostic techniques are used to confirm doubtful cases of hepatic hydrothorax. [1] Here we describe an unusual case of pleural chylothorax secondary to hepatic hydrothorax(HH). CASE PRESENTATION: 68 yr-old-female with history of NASH liver cirrhosis, portal hypertension, RCC of the kidney s/p right partial nephrectomy, chronic kidney disease and MGUS presented with shortness of breath and abdominal distention. On examination she had diminished breath sounds and abdominal ascites with fluid thrill. Initial CT chest, abdomen and pelvis showed moderate right pleural effusion with liver cirrhosis and moderate ascites. During the course of her hospitalization, she underwent multiple diagnostic and therapeutic paracentesis and thoracentesis. Analysis of the pleural fluid was consistent with chylothorax, ascitic fluid had elevated triglycerides however was not diagnostic of chylous ascites. Microbiological work up was negative. No malignant cells were identified. She was started on optimal diuretic therapy. A peritoneum shunting study with SPECT/CT using technetium 99m MAA was performed with evidence of hepatic hydrothorax, following which she underwent a Transjugular intrahepatic portosystemic shun (TIPS) procedure. DISCUSSION: Spontaneous chylothorax after liver cirrhosis is a known entity. Triglyceride levels >200 mg/dl in ascitic fluid [2] and >110 mg/dl in pleural fluid is consistent with a chylous effusion. Migration of intraperitoneally infused 99mTc-labeled microspheres of human serum albumin or a sulfur colloid into the pleural cavity confirms the diagnosis of hepatic hydrothorax in unequivocal cases. The rate of isotope movement indicates the size of defects in the diaphragm. Ditah et al provided a systematic review and meta-analysis of a total of 198 patients suffering from HH where TIPS successfully eliminated the symptoms of refractory HH in 73% of cases. [3] CONCLUSIONS: In conclusion patient developed chylothorax from her ascites which was not evident on initial pleural and ascetic analysis. REFERENCE #1: [1] Dmitry Victorovich Garbuzenko, Nikolay Olegovich Arefyev, Hepatic hydrothorax: An update and review of the literature, World J Hepatol 2017 November 8; 9(31): 1197-1204 REFERENCE #2: [2] Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment Richa Bhardwaj*1, Haleh Vaziri1, Arun Gautam1, Enrique Ballesteros2, David Karimeddini3 and George Y. Wu1 1 Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA; 2 Department of Pathology and Lab Medicine, UCONN Health, Farmington, CT, USA; 3 Department of Diagnostic Imaging and Therapeutics, UCONN Health, Farmington, CT, USA REFERENCE #3: [3]Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis. World J Hepatol 2015; 7: 1797-1806 [PMID: 26167253 DOI: 10.4254/wjh.v7.i13.1797] DISCLOSURES: No relevant relationships by Bharat Bhandari, source=Web Response No relevant relationships by Saadia Faiz, source=Web Response No relevant relationships by Carlos Jimenez, source=Web Response

Evaluation of treatment options for postoperative and spontaneous chylothorax in adults.

Both postoperative and spontaneous chylothorax remain therapeutic challenges without recommendations for a standardized treatment approach. Regardless of its aetiology, patients with chylothorax experience prolonged hospitalization and suffer from the associated complications or the invasive therapy administered. We conducted a retrospective, observational review of adult patients with chylothorax treated between January 2010 and September 2019. The primary end point was successful management with sustained cessation and/or controlled chylous output. Therapy duration, inpatient stay and the incidence of complications were evaluated as secondary end points. Of the 36 patients included (22 men; median age 63 years), 24 patients (67%) suffered from a postoperative accumulation of chylous fluid in the pleural space; in the remaining 12 (33%) patients, chylothoraces occurred spontaneously. Initial conservative treatment was successful in 42% (n = 15); in the other 20 cases (56%) additional invasive therapeutic strategies were followed. A complicated course requiring more than 1 treatment was seen in 54% (n = 13) of the postoperative and in 58% (n = 7) of the spontaneous cases. The median length of hospitalization was significantly longer in the postoperative group (37.5 vs 15.5 days; P = 0.016). Serious complications were observed only in the postoperative group (P = 0.28). There were no in-hospital deaths. Basic treatment of both postoperative and spontaneous chylothorax should include dietary measures in all patients. Additional sclerosing radiotherapy and interventional or surgical therapy are often necessary. The choice of therapeutic approach should be indicated, depending on the aetiology and development of the chylothorax. Early, multimodal treatment is recommended.

Conservative management of chylothorax in infants using octreotide

Background: Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates and infants. Chylothorax causes respiratory and nutritional problems and has a significant mortality rate. Octreotide is a long-acting somatostatin analogue that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.Methods: Infants with spontaneous chylothorax over a period of 3 years were included in this study. A prospective, observational study was done. All patients were nil per oral initially. Oral feeds were resumed once the ICD output declined. Octreotide was given subcutaneously for all patients at a dose of 40 microgram/kg/day in 3 divided doses. Octreotide was stopped once the ICD output was less than 70-80 ml/day. ICD was inserted in all patients and removed once drainage was below 50 ml/day.Results: Five patients were diagnosed with chylothorax over a period of 3 years out of which 3 were male and 2 were females. 1 patient had right sided and 4 patients had left sided chylothorax. The average age of presentation was 5.6 months. Octreotide was administered for an average of 14.4 days (8-22 days). The average duration of ICD was 18.2 days. All patients recovered well and were discharged.Conclusions: Spontaneous chylothorax is rare in infants. Conservative management is usually successful. Early institution of oral feeds with octreotide preserves the child’s nutrition and avoids invasive procedures, such as reinsertion of chest tubes or surgery.

Chemical pleurodesis and somatostatin in treating spontaneous chylothorax in pediatric patients: a retrospective analysis and review of the literature.

BackgroundChylothorax is a rare disease, defined as an abnormal accumulation of chylous lymphatic effusion in thoracic cavity, with a high mortality rate in pediatric patients. At present, there are few studies on the treatment of pediatric chylothorax, and conservative treatments like somatostatin (SST) and pleurodesis are performed empirically. SST has been used for treating pediatric chylothorax over 20 years, and povidone-iodine chemical pleurodesis (PICP) is adopted in recent years with a high cure rate, but both the effect are still uncertain. The safety and efficacy of SST and PICP in treating pediatric chylothorax was compared in this study.MethodsFrom January 2009 to May 2020, 27 pediatric chylothorax patients who accepted life support, SST and PICP treatment were retrospectively reviewed in this study. Their medical history, clinical manifestations, pleural effusion examinations, treatment methods, effects, and complications were screened. PICP and SST was performed in 19 and 8 children, respectively. Each patient was followed up after discharge from the hospital.ResultsAfter admission, chest X-ray and ultrasound diagnosed pleural effusion in 27 patients (18 males and 9 females), including 13 and 6 cases on the left and right side, and 8 cases on both sides. In the pleural effusion, the mean leukocyte count was (9,826±9,482)×106/L, the mean lymphocyte ratio was (84.82±6.58)%, the mean triglyceride content was 7.11±6.63 mmol/L. In PICP and SST group, the mean length of stay was 38.42±19.42 and 35.13±12.72 d (P=0.664), the mean time of thoracic drainage was 24.58±16.34 and 19.63±8.88 d (P=0.440), the mean time of parenteral nutrition was 27.16±18.29 and 25.25±13.52 d (P=0.793), respectively. PICP was performed for 3.16±2.27 times, and SST was used for 14.75±9.08 d with the dosage of 0.5 to 10 µg/kg/hour. After the treatment, all patients in PICP group had mild chest pain and low-grade fever, and 12 cases were observed with transient decrease of oxygen saturation. Eight patients in SST group had nausea and vomit, and 1 child had diarrhea simultaneously. Both were cured by symptomatic treatment, thoracic drainage and discontinuing using SST. Three children were diagnosed with refractory chylothorax and cured by PICP after SST. Pleural effusion in 27 patients was finally absorbed. All of them achieved a clinical cure successfully, and there was no recurrence during discharge follow-up.ConclusionsPICP has a high success rate and few adverse reactions in treating spontaneous chylothorax in pediatric patients, expected to be a new treatment option for pediatric chylothorax after SST.

Povidone-iodine chemical pleurodesis in treating spontaneous chylothorax in pediatric patients.

Chylothorax is a rare disease with a high mortality rate in pediatric patients like newborns and infants. As one of the minimally invasive treatments, chemical pleural pleurodesis has been gradually used in treating pediatric chylothorax patients in recent years. This study explored the feasibility, safety and effect of povidone-iodine chemical pleurodesis (CP) for spontaneous chylothorax in young pediatric patients. From January 2009 to December 2019 the clinical data of 22 children treated for spontaneous chylothorax at Guangdong Second Provincial General Hospital were retrospectively analyzed. The data included the patients' medical history, clinical manifestations, pleural effusion examinations, treatment methods, and effects and complications. On the basis of conventional conservative treatment and closed thoracic drainage, all the children were treated by CP with povidone-iodine until the pleural effusion was absorbed and the thoracic tube was removed. After discharge from the hospital, each patient was followed up for 1-10 years. Of the 22 children (16 males and 6 females), 3 cases were diagnosed with pleural effusion at prenatal examination, 5 cases had acute respiratory distress at birth, and 6 case had experienced pneumonia repeatedly since birth. All of the children had different degrees of cyanosis and dyspnea. Pleural effusion was diagnosed in all patients by chest X-ray and chest ultrasound after admission (12 cases on the left side, 5 cases on the right side, and 5 cases on both sides). The results of all chyle tests during pleural effusion examination were positive. The mean leukocyte count was (9,278.8±9,504.6)×106 /L, the lymphocyte ratio was (83.9±6.1)%, and the mean triglyceride content was (7.18±6.10) mmol/L. All patients were treated with thoracic drainage, diet control, nutritional support, and povidone-iodine CP, among 6 of them with pneumonia on admission received antibiotics. The mean length of stay (LOS) was (36.0±18.2) days. The patients received thoracic drainage for (23.0±15.6) days and pleurodesis (3.0±2.0) times. No serious side effects occurred after pleurodesis, although some patients experienced mild chest pain and low fever. All the patients successfully achieved a clinical cure. Povidone-iodine CP is a safe, effective, and minimally invasive treatment, with high success rate and few complications in young pediatric patients with spontaneous chylothorax.

Clinical case: congenital chylothorax and chyloperitoneum in a premature newborn

Congenital malformations of the heart and great vessels are found in 1% (1 in 100 newborns) among newborns. They are hold the second place after congenital malformations of the nervous system. One of these types of malformations are congenital malformations of the thoracic lymphatic duct. Unlike other anomalies of the great vessels, they are quite rare, and detected with a frequency of 1: 15000 newborns. A consequence of this prevalence of spontaneous chylothorax in newborns is a poorly understood problem in neonatology.Chylothorax is the most typical clinical manifestation of the thoracic lymphatic duct pathology, which is associated not only with congenital malformations. Nevertheless, the etiology and pathogenesis of spontaneous chylous effusion in newborns are unclear. Most often, chylothorax or chyloperitoneum occurs in premature infants.Today there are two ways of chylothrax treatment: conservative and surgical. In the past, for a long time, mortality from chylothorax has been 50-100%. Currently, with the introduction of modern methods of intensive care into practice, mortality from chylothorax in newborns, according to published data, has decreased to 30-50%, but remains quite high, which explains the significance of this pathology.The problem is also of clinical interest due to the small number of observations and the lack of a protocol for the management of chylothorax in newborns, especially in combination with chyloperitoneum and lymphedema.Nevertheless, this case report is interested due to achievement complete recovery of the patient, despite the pessimistic prognosis. The severity of the condition of the child required hospitalization in the neonatal intensive care unit and measures to support vital functions, drainage of the pleural cavity, octreotide infusion for 17 days, and chemical pleurodesis with 10% povidone-iodine solution.Analyzing this case, we noted the low efficiency of using only one particular method of therapy in the treatment of chylothorax and the rapid regression of symptoms after complex treatment, which was supplement with an invasive procedure - pleurodesis - in combination with the continuous administration of norepinephrine. Thus, due to this complex treatment this case distinguishes from standard recommendations.

Retroaortic closure of thoracic duct in the management of persistent chylothorax: a case report

BackgroundChylothorax is a life-threatening pathological condition associated with significant morbidity and mortality. If chyle leakage does not close spontaneously with medical therapy, surgical treatment is inevitable. Herein, we reported a case of spontaneous persistent chylothorax from mediastinal seminoma that was successfully closed between the descending thoracic aorta, and the vertebral column through a left mini-thoracotomy.Case presentationA 24-year old man with mediastinal seminoma was referred to our attention for management of high output persistent chylothorax (> 800 ml/24 h for 30 days) that did not close with conservative treatment. As the leak was isolated within left upper chest cavity, we planned to close the thoracic duct via Poirier’s triangle by uniportal thoracoscopy. However, the long conservative treatment favoured the formation of multiple, tenacious, and bleeding adhesions that made unfeasible thoracoscopy. A conversion to mini-thoracotomy was performed; by the incision of the posterior parietal pleura, the thoracic duct was isolated and ligated behind the thoracic aorta, in an anatomical space delimited by the 4th and the 5th posterior intercostal arteries and the vertebral column.ConclusionsComplete resolution of chylothorax was obtained the day after. Patient was discharged on post-operative day 5, and no recurrence was observed during the follow-up.

Late-onset chylothorax during chemotherapy after lobectomy for lung cancer

Rationale:Chylothorax is usually diagnosed within a few days after lobectomy. Late-onset chylothorax following trauma or thoracic surgery is rare but potentially lethal, lacking reliable preventive methods.Patient concerns:A 54-year-old male patient complained of dyspnea during adjuvant chemotherapy on the 35th postoperative day after right middle lobectomy and systemic lymph node dissection (SLND) for lung cancer. His computed tomography indicated massive pleural effusion filling in the right chest cavity.Diagnoses:The patient was primarily diagnosed as late-onset chylothorax, without definite evidence to exclude spontaneous chylous leakage.Interventions:Uniportal video-assisted thoracoscopic thoracic duct ligation (TDL) was performed for him, as conservative treatment using octreotide with fat-free diet turned out to be ineffective.Outcomes:His pleural effusion was gradually diminished after reoperation, and the patient was discharged 9 days after TDL.Lessons:Postoperative late-onset or spontaneous chylothorax should be kept in mind after pulmonary resection and SLND, and the exclusion of chylous leakage could be considered as a precondition of chest tube removal.

Linksseitiger Chylothorax und Tumor des rechten vorderen Mediastinums

An 82-year-old male patient presented with a left-sided spontaneous chylothorax. A computed tomographic scan of the chest revealed a cystic tumor in the right upper anterior mediastinum and nodules in the left mediastinum that we interpreted as enlarged lymph nodes. On suspicion of lymphoma and for therapy of chylothorax, we performed a left-sided thoracotomy. The putative lymph nodes proved to be chylomas. We interpret the right-sided mediastinal tumor as cystic lymphangioma causing the left-sided chylothorax at the junction of thoracic duct and venous system on the right side.

RECURRENT NECK SWELLING LEADS TO MULTIPLE SPONTANEOUS CHYLOTHORACES

SESSION TITLE: Disorders of the Pleura 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Spontaneous Chylothorax is a rare clinical entity and often with an obscure presentation. Chylothorax is defined as the presence of chyle in the pleural space. The etiology of this condition is often traumatic however, non-traumatic etiologies including malignancies such as lymphoma and other autoimmune conditions can occur. CASE PRESENTATION: 69 year old female with no significant past medical history presents to the ED with painless swelling on the left side of her neck. While driving back to Scottsdale Arizona from Montana she noticed an acute swelling on the left side of her neck. The patient experienced some generalized chest tightness and shortness of breath with the neck swelling. She denied recent history of fever, chills, weight loss, malaise, rash, or arthralgias. On exam, her vitals, joint, lymphatic and abdominal exams were all normal except for non-tender swelling on the left neck. A neck CT demonstrated either edema, hematoma, or other infiltrating process involving the root of the left neck, the left chest wall and axilla, the mediastinum, and the upper retroperitoneum without abscess, obvious mass, abnormal enhancement, or vascular abnormality. There were small pleural effusions. A thoracentesis was performed and cloudy white fluid was extracted from the left pleural space. Pleural fluid analysis was significant only for the findings of chylomicrons. Further imaging with a nuclear lymphatic scan showed an intact thoracic duct without evidence of lymphatic leak. The patient had a normal CBC, CMP, ESR, CRP, SPEP, lymphocyte panel, fungal screening and cancer markers. Patient’s ANA returned positive with a speckled pattern and at titer of 1:160, however, additional markers for lupus were done and all returned negative. At that time the patient’s symptoms resolved and she was discharged. Patient presented two months later with a second episode. The supraclavicular swelling was now painful and associated with pleuritic chest pain and tightness. Further workup for lymphoma and auto-immune causes included a bone marrow biopsy that did not show any evidence of lymphoma, a negative flow cytometry study, a repeat nuclear lymphoscintigraphy of the head was negative for lymphatic leak. She experienced 14 more episodes of neck swelling over the course of 6-8 months and went to Mayo for a second opinion and a PET scan showed no evidence of malignancy or obstruction. DISCUSSION: Based on testing done to date, no evidence of a lymphoproliferative disorder, autoimmune disease or malignancy has been detected. Chylothorax accounts for approximately 3% of pleural effusions in adults. Primary etiology is malignancy with 75% of cases being lymphoma. Other rare conditions include lymphangiomyomatosis, sarcoidosis, tuberculosis, venous thrombosis, congenital lymphatic malformations and trauma. CONCLUSIONS: With no clear etiology the diagnosis falls into the category of spontaneous chylothorax. Reference #1: Etiology of Chylothorax in 203 PatientsClinton H. Doerr, Mark S. Allen, Francis C. Nichols III, Jay H. RyuMayo Clinic Proceedings, Vol. 80, Issue 7, p867–870, July 2005 Reference #2: Varona Porres D, Persiva O, Pallisa E, Sansano I. Diagnostic imaging in spontaneous rupture of a thoracic duct cyst in the mediastinum. Radiologia. 2016;58(6):491-495 Reference #3: Lyon S, Mott N, Koukounaras J, Shoobridge J, Hudson PV. Role of interventional radiology in the management of chylothorax: A review of the current management of high output chylothorax. Cardiovasc Intervent Radiol. 2013;36(3):599-607 DISCLOSURES: No relevant relationships by Alexis MacDonald, source=Web Response No relevant relationships by Kimberly Parker, source=Web Response

Left-sided chylothorax due to tuberculosis in an adult

A spontaneous chylothorax is rare. Chylothorax as a manifestation of tuberculosis (TB) is very rare even in countries where TB is endemic. We report a case of left sided chylothorax due to TB in a 50-year-old male alcoholic who presented with hypotension and hyponatremia. TB was diagnosed through histopathological examination of mediastinal lymph node biopsy. Initial conservative treatment with four days of tube thoracostomy drainage was effective but chylothorax recurred one week later after starting anti-TB drugs. Resolution of chylothorax was achieved with repeat tube thoracostomy drainage for four weeks and daily anti-TB therapy with isoniazid, ethambutol, rifampicin and pyrazinamide for two months followed by daily isoniazid and rifampicin for four months. Patient recovered well and chylothorax did not recur during the follow up period of three months.

Bilateral spontaneous chylothorax in a newborn and response to octreotide therapy

Chylothorax is an abnormal collection of milky white fluid called chyle in pleural space, and is an uncommon cause of respiratory distress in neonates. There is high morbidity and mortality, if not managed appropriately. Here we report a rare case of congenital bilateral chylothorax presented with respiratory distress in our NICU on day one of life. Thoracocentes revealed chyle on both the sides. In view of high drainage of chylous fluid, besides TPN, Octreotide infusion started and the baby responded well.

Spontaneous chylothorax revealing a mediastinal and abdominal lymph node tuberculosis

Chylothorax is a rare manifestation of tuberculosis. We report a case of spontaneous chylothorax due to tuberculosis. A 62-year-old woman was admitted with fever, chest pain and dyspnea. Chest and abdominal computed tomography revealed a fluid collection with necrotic mediastinal and abdominal lymph nodes. Biopsy of lymph nodes by mediastinoscopy. The patient was treated with anti-tuberculosis medication. He is clinically improved and his pleural effusion also completely resolved.

Therapeutic Pneumoperitoneum: Relevant or Obsolete in 2015?

Background Therapeutic pneumoperitoneum (TP) is one alternative to manage pleural space problems. We describe our technique and experience. Materials and Methods Medical records of all patients who underwent TP from January 1, 2007, to January 1, 2015, were reviewed after Institutional Review Board approval. We report indication, preprocedure pulmonary function tests, volume of insufflated air, time to chest tube removal, and complications. We place a red rubber catheter into the peritoneal space through the diaphragm or a small abdominal incision, insufflate with room air, record volume (liters), intraperitoneal pressure (goal 9-10 mm Hg), and monitor vital signs, airway pressures, and urine output. Results We performed TP in 32 patients. Follow-up was available for 31 patients. Indications were prevention of pleural space problems in bilobectomy patients (n = 11), following decortication for empyema (n = 11), prevention of prolonged air leak (n = 3), prevention of postresection space (n = 4), and spontaneous chylothorax (n = 2). TP was done postoperatively in three patients. Median air volume used was 3.5 L (3-6 L). Time to chest tube removal overall was 7.8 days (3-20 days) and to discharge 10.2 days (4-32 days). No patient developed respiratory failure, renal failure, or required evacuation of TP. Conclusion TP is a simple, safe, and effective technique to manage pleural space problems. Proper patient selection and meticulous technique are imperative for the successful clinical application of TP. We believe that TP is an underutilized tool for the management of pleural space problems and merits wider application in thoracic surgical practice.