scholarly journals Chylopericardium Effusion in a Lac Alaotra Bamboo Lemur (Hapalemur alaotrensis)

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 536
Author(s):  
Mara Bagardi ◽  
Jessica Bassi ◽  
Angelica Stranieri ◽  
Vanessa Rabbogliatti ◽  
Daniela Gioeni ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Thoracic Duct ◽  
Subcutaneous Tissue ◽  
Oral Treatment ◽  
Clinical Signs ◽  
Left Hemithorax ◽  
Thoracic Duct Ligation ◽  
Iodinated Contrast ◽  
Duct Ligation

An 11-year-old female Hapalemur alaotrensis was evaluated following a history of dyspnea of 15 days’ duration. Thoracic radiography performed by the referring veterinarian revealed a large cardiac silhouette and dorsal deviation of the trachea. Heart sounds were muffled. Echocardiographic findings were indicative of severe pericardial effusion without cardiac tamponade. No pleural effusion was identified. A computed tomography (CT) exam confirmed the presence of severe pericardial effusion and allowed identification of a parenchymatous mediastinal lesion sited at the level of the left hemithorax. To delineate the thoracic duct, lymphoCT was also performed by injection of iodinated contrast medium in the perianal subcutaneous tissue. Pericardiocentesis yielded a considerable amount of effusion with chylous biochemical and cytological properties. A diagnosis of chylopericardium with absence of pleural effusion was made. Initially, the chylopericardium was managed conservatively with two centesis and oral treatment with prednisolone. Medical treatment did not result in complete resolution of effusion and clinical signs; therefore, subtotal pericardiectomy and thoracic duct ligation were recommended. After the second pericardiocentesis, the subject died and the pericardiectomy could not be performed. To the authors’ knowledge, this is the first report of the development of chylopericardium in a Hapalemur alaotrensis.

QUILOPERICARDIO ESPONTÁNEO EN EDAD PEDIÁTRICA ¿HAY UN ALGORITMO DE MANEJO IDÓNEO?

2020 ◽  
Vol 31 (1) ◽  
Author(s):  
Oscar Eskola Villacís ◽  
Laura Ordóñez León
Keyword(s):  
Pericardial Effusion ◽  
Thoracic Duct ◽  
Pediatric Population ◽  
Management Options ◽  
Mediastinal Tumors ◽  
Pericardial Space ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Chest X Ray ◽  
Invasive Techniques

Introduction: Chylopericardium is the presence of chylous fluid in the pericardial space. The most frequent causes of this rare entity are secondary to surgery and other invasive techniques on the thorax, followed by idiopathic ones, although they have also been associated with congenital anomalies of the lymphatic system, lymphangiomas and other mediastinal tumors, tuberculosis, etc. Its appearance is more common in adults, but lately cases have been described equally between the pediatric population and adults. Cases Reports: The presence of two patients of 8 and 11 months of age who present with significant amount of fluid at the level of the pericardium with involvement of right cardiac chambers in whom the pericardiocentesis performed reveals chyle without a frank pathological association is reported. Different managements with a single purpose, to achieve the ideal treatments for each case. Results: Two patients were identified from our surgical registry in the period described. The first corresponded to a male, of 11 months of age, without significant antecedents, with evidence of chylous pericardial effusion of spontaneous appearance that did not yield to the established conservative measures and later went to surgery for ligation of the thoracic duct and partial pericardiectomy. The second is a patient recently evaluated in the area of pediatrics, male, of 8 months, with Down Syndrome who comes to emergency of our hospital due to the presence of dyspnea, general malaise and food intolerance. The chest X-ray revealed the presence of cardiomegaly and a complementary transthoracic echocardiogram revealed severe pericardial effusion with signs of cardiac tamponade. Diagnostic and evacuation pericardiocentesis was performed with a pediatric central catheter, obtaining serous fluid and draining 35 cc, but three days after the puncture, the exit of chylous fluid through the catheter maintained in the pericardial space was observed. Conservative management is conditioned for a period of 7 days. The rest of the literature review identifies 18 pediatric patients with the presence of a spontaneously occurring pericardial effusion with different treatments offered. Discussion and Conclusions: Chylopericardium is a pathology of rare appearance, the main etiologies define patients who have been taken to cardiac or thoracic surgery. The most categorical description is given for adulthood but in the pediatric age (under 18 years) has not been described a consensus management yet for the variability of its diagnosis, however management remains uncertain after its appearance in those who debuted with primary chylopericardium or spontaneous origin, but despite this the implementation of conservative measures such as enteral nutrition with fatty acids of each media and use of parenteral nutrition between 7 to 15 days; and after the failure of these measures, surgery with thoracic duct ligation by right thoracotomy plus pleuropericardial window confection or partial pericardiectomy are the most successful management options that are known to date with good results in the short and medium term.

scholarly journals Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Chigozirim N. Ekeke ◽  
Ernest G. Chan ◽  
James D. Luketich ◽  
Rajeev Dhupar
Keyword(s):  
Pleural Effusion ◽  
Follicular Lymphoma ◽  
Thoracic Duct ◽  
Malignant Pleural Effusion ◽  
Clinical Course ◽  
Fluid Management ◽  
Patient Specific ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Surgeon Experience

Chylothorax occurs following dysfunction or disruption of the lymphatic drainage along the thoracic duct. Malignant and traumatic causes account for the majority of these occurrences, with lymphoma accounting for 11-37% of chylothoraces. The clinical course of chylothorax may include dehydration, malnutrition, immunosuppression, electrolyte disturbances, infection, and ultimately death. Management of chylothorax is patient-specific and is based on etiology and surgeon experience. Initially, most chyle leaks are managed with nonoperative strategies, such as gut rest, hyperalimentation, and pleural drainage, and, at times, medium-chained fatty acid diet or octreotide, with hopes to decrease chyle production (Zabeck et al. (2011)). High-output chyle leaks following iatrogenic injury or trauma are commonly managed with thoracic duct ligation. Lymphangiography with or without thoracic duct embolization has become increasingly popular and efficacious with the possible benefit of less morbidity (Cope et al. (2002)). We report a case of a 61-year-old male with delayed chylothorax while having an indwelling pleural catheter for malignant pleural effusion during treatment of follicular lymphoma. Percutaneous thoracic duct embolization was attempted but was unsuccessful. Chemotherapy, fluid management, and nutritional support allowed this to resolve over the course of ninety days from diagnosis. We describe the patient’s clinical course and highlight nonoperative management of delayed chylothorax in the setting of follicular lymphoma treatment.

scholarly journals Combination Therapy with Etilefrine and Pleurodesis for Refractory Congenital Chylothorax

2020 ◽  
Vol 5 (3) ◽  
pp. 1-5
Author(s):  
Yutaro Tomobe ◽  
Uiko Mizuguchi ◽  
Akihiro Shimotakahara ◽  
Naoki Shimojima ◽  
Kaoru Okazaki
Keyword(s):  
Pleural Effusion ◽  
Combination Therapy ◽  
Thoracic Duct ◽  
Preterm Neonate ◽  
Chemical Pleurodesis ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Chylous Pleural Effusion ◽  
Congenital Chylothorax ◽  
Viable Treatment

Etilefrine, a sympathomimetic agent, is reportedly effective against postoperative chylothorax. However, its effectiveness in treating congenital chylothorax was unknown. We report herein a case of refractory congenital chylothorax treated with etilefrine in a late preterm neonate with massive fetal chylous pleural effusion. The chylothorax was unresponsive to previous treatments, including dietary and pharmacological treatment and thoracic duct ligation. The pleural effusion decreased after intravenous etilefrine was begun on day of life (DOL) 84 and resolved after the addition of chemical pleurodesis with OK-432 on DOL 90. This combination therapy may be a viable treatment option for cases of congenital chylothorax that are unresponsive to other treatments.

Thoracic duct injury after decortication of lung, new technique to repair thoracic duct in this challenging situation: A case report

2021 ◽  
pp. 021849232199708
Author(s):  
Nandkishore Kapadia ◽  
Saumya Sekhar Jenasamant ◽  
Ganesh Sohan Singh Rawat ◽  
Shailesh Kamkhedkar ◽  
Pratik Shah ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Left Lung ◽  
Lower Lobe ◽  
Late Complications ◽  
Patch Repair ◽  
Double Lumen Tube ◽  
Complex Case ◽  
Thoracic Duct Injury ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Background Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Very few patients respond to conservative line of therapy. Thoracic duct ligation is often the treatment of choice in post-surgical patients; however, the optimal treatment of this disease process after traumatic injury remains unclear. Case presentation: We present the case of a 46-year-old woman with thoracic duct injury secondary to decortication for post-pneumonic empyema. Conservative therapy and pleurodesis done twice failed. She developed severe cachexia losing 15 kg in 30 days. She was referred to our center for ligation of thoracic duct. Preoperative lymphangiography located the duct injury in upper part of mediastinum. Computerized tomography scan of chest showed collapse of left lower lobe and thickened left pleura, indicating a significant pericardial effusion. She underwent decortication of left lung, pericardial window, and native pericardial patch repair of thoracic duct. Results and Conclusions: In this unusual and complex case, successful resolution of the chyle leak was achieved with new surgical technique of patch repair. The patient recovered well and was now on a normal diet. She has put on 12 kg in four months. We have avoided late complications of thoracic duct ligation by this technique. This nouvelle technique may be recommended as it is simple and effective. Ligation of thoracic duct carries late complications. Isolating right lung by double lumen tube may cause severe hypoxia as left-sided lung is not expanded as in this case.

665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Clara Santos ◽  
Laura Santos ◽  
Leticia Datrino ◽  
Guilherme Tavares ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Thoracic Duct ◽  
Meta Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Abstract   During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

scholarly journals Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

2020 ◽  
Vol 8 (2) ◽  
pp. 767
Author(s):  
Oluwaseun R. Akanbi ◽  
Swaminathan Vaidyanathan ◽  
Prakash Agarwal ◽  
Janeel Musthafa ◽  
Neville A. G. Solomon
Keyword(s):  
Thoracic Duct ◽  
Medium Chain Triglyceride ◽  
Cystic Lymphangioma ◽  
Satisfactory Outcome ◽  
Thoracic Duct Ligation ◽  
Risk Of Mortality ◽  
Duct Ligation ◽  
Surgical Options ◽  
Polytetrafluoroethylene Patch ◽  
Substantial Morbidity

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

Uniportal video-assisted thoracoscopic surgery right thoracic duct ligation

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 056-056
Author(s):  
Pei Fern Koh ◽  
Narasimman Sathiamurthy ◽  
Nguk Chai Diong ◽  
Benedict Dharmaraj
Keyword(s):  
Thoracic Duct ◽  
Thoracoscopic Surgery ◽  
Video Assisted ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Video Assisted Thoracoscopic Surgery

Laparoscopic Transhiatal Thoracic Duct Ligation for Chylothorax after Esophagectomy

2019 ◽  
Vol 67 (07) ◽  
pp. 606-609 ◽  
Author(s):  
Yukinori Yamagata ◽  
Kazuyuki Saito ◽  
Kosuke Hirano ◽  
Masatoshi Oya
Keyword(s):  
Esophageal Cancer ◽  
Conservative Treatment ◽  
Thoracic Duct ◽  
Thoracic Cavity ◽  
Transthoracic Approach ◽  
Thoracic Esophageal Cancer ◽  
Transhiatal Approach ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Laparoscopic Transhiatal Approach

AbstractIn esophagectomy for thoracic esophageal cancer, chylothorax may develop at a certain frequency. For chylothorax, conservative treatment is selected first, but if it is not improved, thoracic duct (TD) ligation is considered. In general, transthoracic approach is chosen to reach the TD. However, it is sometimes difficult to identify the TD due to adhesion in the thoracic cavity. Hence, we selected a laparoscopic transhiatal approach to the TD. We introduce the procedure of our laparoscopic transhiatal TD ligation technique.

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