Bilateral Chylothorax Following Left Neck Dissection and Literature Review

Abstract Background: Although chyle leakage may occur in the neck when the thoracic duct is damaged during cervical dissection, it is extremely rare for the chylothorax alone to leak chyle into the thoracic cavity. Case presentation: We report a case of bilateral chylothorax without chyle cervical leakage after left neck dissection, wherein partial left upper jaw resection and left radical neck dissection were performed in a 46-year-old woman who was diagnosed with left upper gingival cancer. The thoracic duct was ligated and cut during surgery and, although no obvious leakage of lymph was observed, dyspnea and cough reflex during deep inhalation were observed from the 3rd postoperative day. Approximately 600 mL of yellowish-white pleural effusion was aspirated during bilateral thoracentesis, and chylothorax was diagnosed based on clinical findings and biochemical analysis results. The patient was put on a low-fat diet on the 4th postoperative day, and a total of 3 neck drains were removed 8 days after the operation. Conclusions: Pleural effusion disappeared on imaging examination 16 days after thoracentesis and 5 years and 6 months have passed since the operation. At this time, there has been no evidence of tumor recurrence, metastasis, or pleural effusion.

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Bilateral Chylothorax Following Left Neck Dissection and Literature Review

10.21203/rs.3.rs-141175/v2 ◽

2021 ◽

Author(s):

Sachiko Kimizuka ◽

Hiroyuki Yamada ◽

Koji Kawaguchi ◽

Toshikatsu Horiuchi ◽

Akira Takeda ◽

...

Keyword(s):

Pleural Effusion ◽

Neck Dissection ◽

Thoracic Duct ◽

Radical Neck Dissection ◽

Clinical Findings ◽

Cough Reflex ◽

Low Fat Diet ◽

Bilateral Chylothorax ◽

Left Neck ◽

Chyle Leakage

Abstract BackgroundAlthough chyle leakage may occur in the neck when the thoracic duct is damaged during cervical dissection, it is extremely rare for the chylothorax alone to leak chyle into the thoracic cavity. Case presentationWe report a case of bilateral chylothorax without chyle cervical leakage after left neck dissection, wherein partial left upper jaw resection and left radical neck dissection were performed in a 46-year-old woman who was diagnosed with left upper gingival cancer. The thoracic duct was ligated and cut during surgery and, although no obvious leakage of lymph was observed, dyspnea and cough reflex during deep inhalation were observed from the 3rd postoperative day. Approximately 600 mL of yellowish-white pleural effusion was aspirated during bilateral thoracentesis, and chylothorax was diagnosed based on clinical findings and biochemical analysis results. The patient was put on a low-fat diet on the 4th postoperative day, and a total of 3 neck drains were removed 8 days after the operation. ConclusionsPleural effusion disappeared on imaging examination 16 days after thoracentesis and 5 years and 6 months have passed since the operation. At this time, there has been no evidence of tumor recurrence, metastasis, or pleural effusion.

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Lymphatic Drainage System after Left Radical Neck Dissection

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410300108 ◽

1994 ◽

Vol 103 (1) ◽

pp. 46-48 ◽

Cited By ~ 10

Author(s):

Gady Har-El ◽

Frank E. Lucente

Keyword(s):

Pleural Effusion ◽

Neck Dissection ◽

Thoracic Duct ◽

Lymphatic Vessel ◽

Lymphatic System ◽

Radical Neck Dissection ◽

Drainage System ◽

Lymphatic Drainage ◽

Venous System ◽

Collateral System

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.

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Bilateral chylothorax following left radical neck dissection (Case report)

The Journal of Laryngology & Otology ◽

10.1017/s002221510010475x ◽

1988 ◽

Vol 102 (3) ◽

pp. 288-290 ◽

Cited By ~ 12

Author(s):

A. Pace-Balzan ◽

B. Moriarty

Keyword(s):

Case Report ◽

Neck Dissection ◽

Thoracic Duct ◽

Single Case ◽

Rare Complication ◽

Radical Neck Dissection ◽

Bilateral Chylothorax ◽

Number Of Patients

SummaryBilateral chylothorax is a rare complication of radical neck dissection and was first described in 1907. Stuart (1907) reviewed a number of patients with injuries to the thoracic duct in the neck and reported on three patients with bilateral chylothotax, all of whom died. The condition was not reported again until 1951 when the first of the five single case reported published to date appeared. The rarity with with which this complication is reported makes it difficult for clinicians to be familiar with it. A further case is reported and the relevant literture, and certain aspects of the aetiology and management are discussed.

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Bilateral chylothorax following left-sided radical neck dissection

The Journal of Laryngology & Otology ◽

10.1017/s0022215106001344 ◽

2006 ◽

Vol 120 (8) ◽

pp. 705-707 ◽

Cited By ~ 11

Author(s):

S Srikumar ◽

J R Newton ◽

T A B Westin

Keyword(s):

Neck Dissection ◽

Radical Neck Dissection ◽

Favourable Outcome ◽

Bilateral Chylothorax ◽

Life Threatening ◽

Life Threatening Complication

Chylothorax is an extremely rare but potentially life-threatening complication of radical neck dissection. Its rarity makes surgeons unfamiliar with its management. We report the case of a bilateral chylothorax occurring after a left radical neck dissection and discuss its management. A multi-disciplinary approach is advocated, involving surgical, respiratory and dietetic input, and this led to a favourable outcome for our patient.

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Thoracoscopic ligation of the thoracic duct complex in the treatment for high-volume chyle leak following modified radical neck dissection: safe, feasible, but underutilised

Clinical Otolaryngology ◽

10.1111/coa.12210 ◽

2014 ◽

Vol 39 (1) ◽

pp. 73-74 ◽

Cited By ~ 4

Author(s):

P.M. Wilkerson ◽

A. Haque ◽

L. Pitkin ◽

Y. Soon

Keyword(s):

Neck Dissection ◽

Thoracic Duct ◽

Radical Neck Dissection ◽

High Volume ◽

Chyle Leak ◽

Modified Radical Neck Dissection

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Bilateral Chylothorax from Radical Neck Dissection

Otolaryngology ◽

10.1177/019459988509300624 ◽

1985 ◽

Vol 93 (6) ◽

pp. 814-817 ◽

Cited By ~ 21

Author(s):

Richard S. Ng ◽

Richard J. Kerbavaz ◽

Raymond L. Hilsinger

Keyword(s):

Neck Dissection ◽

Radical Neck Dissection ◽

Bilateral Chylothorax

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A Case Report on the Management of Intractable Chyle Leakage after Left Neck Level V Lymph Node Biopsy

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2020.00087 ◽

2021 ◽

Vol 64 (2) ◽

pp. 124-128

Author(s):

Somi Ryu ◽

Byeong Min Lee ◽

Seongjun Won ◽

Jung Je Park

Keyword(s):

Lymph Node ◽

Thoracic Duct ◽

Somatostatin Analogues ◽

Lymph Node Biopsy ◽

Nutritional Limitation ◽

Node Biopsy ◽

Thoracic Duct Ligation ◽

Duct Ligation ◽

Left Neck ◽

Chyle Leakage

Chyle leakage from the neck, which usually occurs after iatrogenic injury of the thoracic or lymphatic duct, is an uncommon complication of head and neck surgeries, which include neck dissection or thyroidectomy. A small amount of chyle leakage can be treated with conservative approaches, such as nutritional limitation, somatostatin analogues, and wound compression. However, massive or uncontrolled chyle leakage requires surgical exploration of the wound and thoracic duct ligation via the chest or transabdominal thoracic duct embolization can be applied. Here, we report a case of intractable massive chyle leakage in a 78-year-old male after a left neck level V lymph node biopsy, which was not controlled after conservative management and explorative surgery. Various treatment approaches were attempted and successful management of chyle leakage was ultimately achieved by thoracic duct embolization.

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Case Report: Management of idiopathic chylothorax

F1000Research ◽

10.12688/f1000research.6694.1 ◽

2015 ◽

Vol 4 ◽

pp. 1049 ◽

Cited By ~ 1

Author(s):

Maher Abouda ◽

Yangui Ferdaous ◽

Miriam Triki ◽

Mehdi Charfi ◽

Mohamed Ridha Charfi

Keyword(s):

Case Report ◽

Pleural Fluid ◽

Medical Therapy ◽

Thoracic Duct ◽

Medium Chain Triglyceride ◽

Pleural Space ◽

Low Fat Diet ◽

Thoracic Duct Ligation ◽

Bilateral Chylothorax ◽

Duct Ligation

Chylothorax is characterized by the presence of chyle in the pleural space and results from lesion or obstruction of the thoracic duct. We present two cases of non-traumatic, idiopathic chylothorax in two females that were treated differently. The first is a 42 year old female who presented with a symptomatic right chylothorax. Treatment by a low-fat diet supplemented with medium chain triglyceride and evacuation of the pleural fluid was sufficient. The second patient is a 25 year old female admitted for a bilateral chylothorax. Despite optimal medical therapy, chylothorax continued to persist. Finally thoracic duct ligation was performed, which resulted in resolution of the effusion. These two cases illustrate that the management of idiopathic chylothorax can be surgical or nonsurgical.

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