Pseudochylothorax in pleural effusion due to coronary artery bypass surgery.
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This study describes a 64-yr-old male with a chronic left pleural effusion following a coronary artery bypass 3 yrs earlier. On thoracocentesis, turbid fluid was obtained with crystals of cholesterol on microscopic examination, establishing the diagnosis of pseudochylothorax. The pleural fluid cholesterol level was 207 mg x dL(-1) (5.36 mmol x L(-1)). This is the first report of pseudochylothorax in a chronic pleural effusion due to coronary artery bypass surgery. (+info)
Chylothorax, chylopericardium and lymphoedema--the presenting features of signet-ring cell carcinoma.
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This report describes a patient with chylous pleural and pericardial effusions in conjunction with severe lymphoedema resembling elephantiasis. The chylous effusions and generalized lymphoedema were associated with a signet-ring cell carcinoma. (+info)
Chylothorax after myocardial revascularization with the left internal thoracic artery.
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A 38-year-old male underwent coronary artery bypass grafting (CABG). A saphenous vein graft was attached to the left marginal branch. The left internal thoracic artery was anastomosed to the left anterior descending artery (LAD). The early recovery was uneventful and the patient was discharged on the 5th postoperative day. After three months, he came back to the hospital complaining of weight loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left pleural effusion. On physical examination, a decreased vesicular murmur was detected. After six days, the diagnosis of chylothorax was made after a milky fluid was detected in the plural cavity and total pulmonary expansion did not occur. On the next day, both anterior and posterior pleural drainage were performed by videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted for ten days. After seven days the patient was put on a low-fat diet for 8 days. The fluid accumulation ceased, the drains were removed and the patient was discharged with normal pulmonary expansion. (+info)
Fatal bilateral chylothorax in mice lacking the integrin alpha9beta1.
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Members of the integrin family of adhesion receptors mediate both cell-cell and cell-matrix interactions and have been shown to play vital roles in embryonic development, wound healing, metastasis, and other biological processes. The integrin alpha9beta1 is a receptor for the extracellular matrix proteins osteopontin and tenacsin C and the cell surface immunoglobulin vascular cell adhesion molecule-1. This receptor is widely expressed in smooth muscle, hepatocytes, and some epithelia. To examine the in vivo function of alpha9beta1, we have generated mice lacking expression of the alpha9 subunit. Mice homozygous for a null mutation in the alpha9 subunit gene appear normal at birth but develop respiratory failure and die between 6 and 12 days of age. The respiratory failure is caused by an accumulation of large volumes of pleural fluid which is rich in triglyceride, cholesterol, and lymphocytes. alpha9(-/-) mice also develop edema and lymphocytic infiltration in the chest wall that appears to originate around lymphatics. alpha9 protein is transiently expressed in the developing thoracic duct at embryonic day 14, but expression is rapidly lost during later stages of development. Our results suggest that the alpha9 integrin is required for the normal development of the lymphatic system, including the thoracic duct, and that alpha9 deficiency could be one cause of congenital chylothorax. (+info)
Paragonimiasis miyazakii associated with bilateral pseudochylothorax.
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A 37-year-old man who suffered from bilateral pleural effusions, subcutaneous abdominal induration and blood eosinophilia, was admitted to our hospital. He had ingested raw crabs at a pub-restaurant before the onset of his symptoms. His pleural effusions were chyliform containing cholesterol crystals, and a high level of immunoglobulin E (36,580 IU/ml) and anti-Paragonimus miyazakii antibody were detected. He was effectively treated with praziquantel. This case suggests that paragonimiasis should be strongly suspected if blood eosinophilia, pseudochylothorax, and a high level of immunoglobulin E in pleural effusion are detected. (+info)
We describe a case of pulmonary lymphangiomyomatosis (LAM) with chylothorax that developed in a 46-year-old Japanese woman. This patient exhibited clinical symptoms of dyspnea and chest X-ray showed right pleural effusion. Thoracocentesis demonstrated chylous effusion. Chest computed tomography (CT) scan revealed multiple cystic lesions. Subsequent thoracoscopy revealed the chylorrhea from swelled vessels on the diaphragm. The clinical diagnosis, based on histological examinations with biopsy specimens obtained by thoracoscopy, was pulmonary LAM. Although the hormone therapy was not effective, chylous effusion was improved by the pleurodesis. Pulmonary LAM developing chylothorax is rare in Japan. (+info)
Thoracoscopic ligation of the thoracic duct.
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OBJECTIVE: When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct. METHODS: A 4-year-old girl developed a right chylothorax following a Fontan procedure. Aggressive nonoperative management failed to eliminate the persistent chyle loss. A 72-year-old insulin-dependent diabetic man was involved in a motor vehicle accident, in which he sustained multiple fractured ribs, a right hemopneumothorax, a right femoral shaft fracture, and a T-11 thoracic vertebral fracture. Subsequently, he developed a right chylothorax, which did not respond to nonoperative management. Both patients were successfully treated with thoracoscopic ligation of the thoracic duct. RESULTS: The child had significant decrease of chyle drainage following surgery. Increased drainage that appeared after the introduction of full feedings five days postoperatively was controlled with the somatostatin analog octreotide. The chest tube was removed two weeks after surgery. After two years' follow-up, she has had no recurrence of chylothorax. The adult had no chyle drainage following surgery. He was maintained on a medium-chain triglyceride diet postoperatively for two weeks. The chest tube was removed four days after surgery. After six months' follow-up, he has had no recurrence of chylothorax. CONCLUSIONS: Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity. (+info)
Video-assisted thoracic surgery for the management of pleural and pericardial effusion in Behcet's syndrome.
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A 28-year-old man, who presented with pleural and pericardial chylous effusion secondary to superior vena cava syndrome, was diagnosed with Behcet's syndrome. A pericardial window was created by video-assisted thoracic surgery to relieve cardiac tamponade, and this technique also enabled lung biopsy, pleural abrasion, and drainage of the pleural effusion. We report this case because of its rarity. To the best of our knowledge, the literature contains no other report of the use of video-assisted thoracic surgery for creating a pericardial window for the treatment of cardiac tamponade in a case of Behcet's syndrome. (+info)