Misdiagnosis of a chylous cyst as chest wall gouty tophus: a case of true pseudogout. (9/50)

A patient referred to us for recurrent chest wall gouty tophus, but who was determined to actually have a chylous cyst, is described herein. Chylous cysts of the neck or chest wall can be caused by thoracic duct injury. Chyle contains 4-40 gm/liter of lipids, mostly triglycerides, and these can form birefringent crystals upon drying, leading to a false diagnosis of gout.  (+info)

Fluoroscopy guided instillation therapy in chyluria using combination of povidone iodine with contrast agent. Is a single instillation sufficient? (10/50)

PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented.  (+info)

Lymphonodovenous anastomosis in the treatment of chyluria. (11/50)

Thirty cases of chyluria were treated by means of lymphonodovenous anastomoses according to the principles of lymphovenous shunt. A conical tissue of lymph node close to the greater saphenous vein in the inguinal region was removed and the remaining tunnel-shaped node was anastomosed to the vein to drain the lymph into the venous system. Twenty-one cases were followed up for six months after the operation. Among them, 16 (76.2%) showed disappearance of chyluria, and 2 (9.5%) were improved, giving an effective rate of 85.7%. This operation avoids damage to both the afferent and efferent lymphatic vessels, and affords a large anastomotic stoma for free passage of the lymph into the vein.  (+info)

Chyluria after partial nephrectomy: case report and review of the literature. (12/50)

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Chyloptysis with right middle lobe syndrome complicated postoperatively by chylothorax: an unusual cause of right middle lobe syndrome. (13/50)

Chyloptysis, in the context of middle lobe syndrome, and chylothorax are rare clinical entities. They are reported in the medical literature mostly as case reports, but never together in the same patient. The present report describes the case of a 34-year-old woman who presented with chyloptysis associated with recurrent right middle lobe syndrome since she was 20 years of age, and eventually underwent right middle lobectomy. A few weeks postoperatively, she developed a right-sided chylothorax, which was refractory to medical therapy, and was successfully treated with thoracic duct ligation. She has been symptom-free for two years postsurgery.  (+info)

Hypercoagulability in a patient with chronic chyluria, proteinuria and hypoalbuminaemia. (14/50)

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Thoracoscopic thoracic duct ligation for persistent cervical chyle leak: utility of immediate pathologic confirmation. (15/50)

OBJECTIVE: Chylous fistulas can occur after neck surgery. Both nonoperative measures and direct fistula ligation may lead to fistula resolution. However, a refractory fistula requires upstream thoracic duct ligation. This can be accomplished minimally invasively. Success depends on lymphatic flow interruption where the duct enters the thorax. We report on the utility of frozen section confirmation in achieving this goal. METHODS: Persistent chylous fistulas occurred in 2 patients after left cervical operations. In the first patient, attempted direct fistula ligation and sclerosant application failed. Fasting, parenteral nutrition, and somatostatin-analog provided no benefit. For the second patient, nonoperative treatment was also ineffective. Prior radiation therapy and multiple cervical operations militated against attempted direct fistula ligation. Both patients underwent thoracoscopic thoracic duct interruption. RESULTS: In both cases, a duct candidate was identified between the aorta and azygos vein. Frozen section analysis of tissue resected between endoclips verified it as thoracic duct. Fistula resolution ensued promptly in both instances. CONCLUSIONS: This report lends further credence to the efficacy of minimally invasive thoracic duct ligation in treating postoperative cervical chylous fistulas. Frozen section confirmation of thoracic duct tissue is useful. It allows one facile with thoracoscopy, but less familiar with thoracic duct ligation, to confidently terminate the operation.  (+info)

Lymphatic abnormalities in Alagille's syndrome. (16/50)

Chylous pleural effusions developed in a patient with Alagille's syndrome who had dysplasia of the lymphatic system. Lymphatic abnormalities are not a recognised feature of Alagille's syndrome.  (+info)