食管癌术后乳糜胸的临床分析

目的 探讨食管癌术后乳糜胸的防治方法。方法 回顾性分析14例食管癌术后并发乳糜胸患者的临床资料。结果 1362例食管癌术后发生乳糜胸14例，发生率1．03％（14／1362），非手术治疗5例，手术治疗9例，均痊愈出院。结论 食管癌术后乳糜胸应本着预防为主、综合治疗的原则，膈上低位胸导管结扎术对治疗和预防食管癌术后乳糜胸，疗效确切。     

Percutaneous radiological management of high-output chylothorax with CT-guided needle disruption

We present the study of a 58-year-old man who underwent percutaneous management of a high-output chylothorax following cardiac bypass graft surgery. The patient presented to a peripheral hospital 3 weeks postoperatively following cardiac bypass graft surgery with shortness of breath. A chest radiograph taken on arrival to the emergency department showed a large left-sided pleural effusion. Subsequent intercostal chest tube insertion drained a large amount of chylous fluid. The patient was treated conservatively with no improvement until undergoing a CT-guided needle disruption of lymphatics with good effect. This case is presented to show the minimally invasive treatment methods that are available in the management of high-output chylothorax.     

Chylothorax and chylous ascites: Management and pitfalls

Leakage of lymph from the lymphatic ducts causes chylothorax (CT) or chylous ascitis (CA). This may happen for unknown reasons during fetal life or after birth and may also be caused by trauma after thoracic surgery or by other conditions. Fetal CT and CA may be lethal particularly in cases with fetal hydrops that sometimes benefit of intra-uterine instrumentation. After birth, symptoms are related to the amount of accumulated fluid. Sometimes, severe cardio-respiratory compromise prompts active therapy. Most patients with CT or CA benefit from observation, rest, and supportive measures alone. Drainage of the fluid may be necessary, but then loss of protein, fat, and lymphoid cells introduce new risks and require careful replacement. Low-fat diets with MCT and parenteral nutrition decrease fluid production while allowing adequate nutritional input. If lymph leakage does not stop, secretion inhibitors like somatostatin or octreotide are prescribed, although there is only weak evidence of their benefits. Imaging of the lymphatic system is indicated when the leaks persist, but this is technically demanding in children. Shunting of the lymph from one body space to another by means of valved catheters, embolization of the thoracic duct, and/or ligation of the major lymphatics may occasionally be indicated in cases refractory to all other treatments.     

Chylopericardium and chylothorax: Unusual mechanical complications of central venous catheters

Obstruction and thrombosis of major systemic veins can occur due to indwelling central venous catheters. If obstruction of the innominate vein or superior vena cava occurs, lymphatic drainage can be impaired due to an increase in pressure in the thoracic duct and lymphatics. We describe a case where superior vena cava syndrome, chylopericardium and chylothorax occurred in a 16‐year‐old girl due to an indwelling central venous catheter. This was successfully treated with removal of the line, anticoagulation and angioplasty of the innominate vein and superior vena cava.     

Multifocal osteolysis with chylous polyserositis and intrathoracic vein thrombosis: a diagnostic challenge for rheumatologists

Vanishing bone disease with multisystemic involvement may mimic systemic autoimmune or autoinflammatory diseases. We present a 19‐year‐old man who was hospitalized due to chest pain following a progressive osteolysis of the bony thorax. The disease later expanded into the pleura, peritoneum and pericardium in a form of massive chylous polyserositis. The patient also developed thrombosis of multiple central veins, which in turn worsened the chylothorax by increasing the pressure in the thoracic duct. This is the first case of vanishing bone disease complicated by triple chylous effusions and central vein thrombosis.     

新生儿乳糜胸二例

新生儿乳糜胸是由胸导管或胸腔淋巴管破裂使淋巴液漏入胸腔所致,可引起严重呼吸困难及营养、免疫障碍,病死率较高。该文报道2例新生儿乳糜胸病例,2例均以呼吸困难、胸腔积液为主要临床表现,胸腔积液淋巴细胞比率均不低于0.8。1例经胸腔穿刺引流术联合一般治疗治愈,1例经阿奇霉素胸膜固定术治愈。2例成功诊治的经验提示临床医师应提高对该疾病的诊治水平,早诊断、及时处理有助于提高该病患儿的生存率。     

Refractory IgG4-related Pleural Disease with Chylothorax: A Case Report and Literature Review

We herein report a rare case of a 66-year-old man with refractory chylothorax. Although he had been treated with moderate doses of prednisolone (PSL) on suspicion of pleuritis with Sjögren syndrome, the pleural effusion expanded after the reduction of PSL. Further workup including histopathological examinations of pleura led to the diagnosis of IgG4-RD with bilateral chylothorax without any leakage from the thoracic duct. Combination therapy with high-dose PSL plus rituximab successfully decreased the pleural effusion. This is a very rare case of IgG4-related pleuritis with chylothorax and the first report of its successful treatment with rituximab.     

Postoperative chylothorax following partial resection of mediastinal lymphangioma: Report of a case

We report herein the rare case of a 20-year-old man in whom a mediastinal lymphangioma was incidentally detected by a chest roentgenogram taken during a routine health examination. Both computed tomography and magnetic resonance imaging confirmed a mass measuring 3×7 cm in diameter in the left anterior mediastinum. A thoracoscopic exploration was done, which confirmed a diagnosis of mediastinal lymphangioma, and 3 days later a sternotomy was performed. However, the tumor could not be completely extirpated due to partial invasion. Following the thoracoscopic procedure, a chylous discharge developed which was difficult to treat conservatively and he continued to drain 700–1,000 ml of chyle daily 2 weeks following the tumor extirpation. Therefore, a right thoracotomy with ligation of the thoracic duct was performed which resolved the chylothorax. The patient remains well without any regrowth of the regional tumor 9 months after his operation.     

LYMPHANGIOMATOSIS OF THE BODY WALL: A Report of Two Cases Associated with Chylothorax and Fatal Outcome

We report on two cases of an unusual but distinctive variant of lymphangiomatosis, presenting at birth with predominantly cutaneous involvement of the body wall and complicated by chylothorax. The lesion manifested clinically as a slowly progressive, diffuse, and fluctuant skin swelling. Eventually, almost the entire trunk became affected. There were no bone lesions. Histologically, the soft tissues were diffusely infiltrated by interconnecting mazelike lymphatic vessels. The two infants died from infection at the age of 23 days and 10 months, respectively. Our experience confirms that premortem histologic diagnosis of lymphangiomatosis is difficult to establish. Awareness of the condition and knowledge of its various clinical presentation forms are essential for proper recognition, assessment of the outcome, and evaluation of new therapeutic measures such as interferon.