Antithrombin activity in children with chylothorax

Bernet‐Buettiker, Vera; Waldvogel, Katharina; Cannizzaro, Vincenzo; Albisetti, Manuela

doi:10.1016/j.ejcts.2005.12.015

Cited by 46 publications

(37 citation statements)

References 10 publications

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“…Chylothorax is characterized by an accumulation of triglycerides and protein-rich fluid in the pleural cavity. The resultant loss of albumin and antithrombin into the pleural space has been postulated to predispose to thrombosis [2,3]. We report the first case of a fatal pulmonary embolism that occurred in the setting of a post-CABG chylothorax in adults.…”

Section: Introductionmentioning

confidence: 94%

Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis

Hoskote¹,

Devarapally²,

Dasgupta

et al. 2013

Blood Coagulation &Amp; Fibrinolysis

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Chylothorax is a recognized complication of intrathoracic surgery, but its occurrence after coronary artery bypass grafting (CABG) is very rare. We report a case of a fatal pulmonary embolism as a complication of chylothorax following CABG. The patient was an 82-year-old woman who presented with increasing chest pain 2 weeks after discharge after an uncomplicated CABG. A computerized tomography (CT) scan with contrast angiogram showed a left-sided pleural effusion and no concurrent pulmonary embolus. Analysis of the pleural effusion revealed a chylothorax, which was treated with chest tube drainage and total parenteral nutrition followed by an oral medium-chain fatty acid diet. The patient improved steadily but, on day 6, she developed acute hypoxemic respiratory failure and shock. A CT angiogram revealed a massive pulmonary embolus and, despite thrombolysis, the patient died. Autopsy confirmed an acute saddle embolus in the pulmonary trunk. The patient had received appropriate venous thromboembolism prophylaxis with subcutaneous unfractionated heparin during her hospital course. This is the first reported case of a fatal pulmonary embolism that occurred in the setting of a post-CABG chylothorax in adults. The occurrence of this complication despite unfractionated heparin thromboprophylaxis may suggest a role for other, more effective medications, such as low molecular weight heparin or fondaparinux in patients with chylothorax.

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Section: Introductionmentioning

confidence: 94%

Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis

Hoskote¹,

Devarapally²,

Dasgupta

et al. 2013

Blood Coagulation &Amp; Fibrinolysis

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“…These include malnutrition, hyponatremia, fluid imbalance, respiratory distress, increased risk of thrombosis, 156 and secondary immunodeficiency. 2 In 1 reported case of selenium deficiency because of loss of selenium in chylous fluid, myopathy associated with severe cardiomyopathy developed.…”

Section: Complications Of Chylothoraxmentioning

confidence: 99%

Chylothorax in Infants and Children

2014

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Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed. Pediatrics 2014;133:722-733

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“…These include pulmonary hypoplasia from long-standing chylothorax in utero, malnutrition, hyponatremia, fluid imbalance, increased risk of thrombosis, 100 and secondary immunodeficiency.…”

Section: Complicationsmentioning

confidence: 99%

Congenital chylothorax: current perspectives and trends

Krishnamurthy

Malhotra

2017

RRN

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Congenital chylothorax (CC) is the most common cause of pleural effusion in the perinatal period. The etiology is unknown in the majority of the cases. However, in some cases, it can be associated with various syndromes and genetic conditions. CC is associated with a high mortality rate. Most of the clinical manifestations are secondary to pressure effects (pulmonary hypoplasia) and loss of protein and lymphatic fluid (hydrops, malnutrition). Conservative management in the neonatal period is effective in up to 80% of cases and includes pleural drainage, parenteral nutrition/enteral medium-chain triglyceride-based formulae, and medications such as octreotide. Surgical intervention (pleurodesis, thoracic duct ligation/embolization, pleuroperitoneal shunt) may be required in persistent cases. A universal consensus on management of CC is unavailable, and data on the safety of medication use for CC in neonates are sparse.

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Antithrombin activity in children with chylothorax

Abstract: Increased loss of antithrombin is present in children with chylothorax, potentially predisposing these children to an increased risk of thrombosis. Repeated antithrombin substitution should be considered in critically ill children with chylothorax.

Cited by 46 publications

References 10 publications

Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis

Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis

Chylothorax in Infants and Children

Congenital chylothorax: current perspectives and trends

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