A staged management of prolonged chylothorax in a patient with yellow nail syndrome

Abstract

SummarySpontaneous chylothorax remains an unusual condition with diverse aetiologies and non-unified management strategies. Owing to the rarity of the condition, the evidence of management remains from case reports and limited retrospective studies. This case represents a difficult-to-manage chylothorax secondary to yellow nail syndrome with initial failure of both surgical and conservative treatment methods. Pleurovenous shunting represents a surgical management approach allowing the patient to live with and control an ongoing chyle leak.BackgroundYellow nail syndrome is a rare disease formed by the clinical triad of pleural effusion, lymph oedema and yellow nails. [1][2][3][4] Massive chylous pleural effusion is often the most challenging aspect of the condition.

Yellow nail syndrome: a case report and review of treatment options

“…When chylous effusions are believed to be due to a defect in the thoracic duct, surgical repair or ligation of the thoracic duct has been suggested as a treatment option, with mixed results Another minimally invasive option is an insertion of a PleurX® catheter (Carefusion, San Diego, CA, USA) rather than intermittent thoracentesis or pleurodesis, though this may lead to chronic protein loss . Pleurectomy, though very invasive can be used for recurrent effusions as well, though there is mixed evidence regarding its efficacy in YNS patients .…”

“…In refractory patients, effusions can be managed with a shunt placement . Pleurovenous shunt to the subclavian vein has had greater reported success than pleuroperitoneal shunts as the latter can be complicated by significant ascites .…”

Pigmentations of the Nails

“…However, the full trias is not always seen. The most common type of respiratory infections are sino-bronchial syndrome and bronchiectasis [3], but other internal diseases and carcinomas were observed in association with the YNS [4][5][6]. The nails show a yellow discoloration, the cuticle is lost spontaneously; the nails virtually stop growing and lose their attachment to the nail bed ( Figure 8).…”