Bilateral spontaneous chylothorax after severe vomiting in children

Rodrigues, Antonio Lucas Lima; Romaneli, Mariana Tresoldi das Neves; Ramos, Celso Darío; Fraga, Andréa de Melo Alexandre; Pereira, Ricardo; Appenzeller, Simone; Marini, Roberto; Tresoldi, Antônia Teresinha

doi:10.1016/j.rppede.2016.04.003

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…A blow to the posterior left thorax sufficient to fracture multiple ribs is more than sufficient to damage the nearby thoracic duct (1)(2)(3)(4). Arguing against this is most patients with large traumatic chylothoraces present within 10 days of injury (1,2).…”

Section: Figure 2 Thoracic Duct Anatomy (Black Arrows)mentioning

confidence: 99%

Infected chylothorax: a case report and review

Eubank¹,

Gabe²,

Kraft³

et al. 2018

Southwest J Pulm Crit Care

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Infected chylothorax is a rare complication of a rare pathology with limited literature entirely consisting of case reports, meeting abstracts, and letters to the editor. The case of a 56-year-old male with a spontaneous infected chylothorax successfully treated and discharged to home without any residual effects is described. A systematic review of the literature revealed 11 prior cases of infected chylothoraces. Their etiologies (when known), initial pleural fluid values, and treatment are described. These cases show that while infected chylothorax has a varied presentation and affects a broad range of patients, conservative management including antibiotics, pleural fluid drainage, and symptomatic relief is a safe and appropriate starting point.

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Section: Figure 2 Thoracic Duct Anatomy (Black Arrows)mentioning

confidence: 99%

Infected chylothorax: a case report and review

Eubank¹,

Gabe²,

Kraft³

et al. 2018

Southwest J Pulm Crit Care

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“…[49], [51-52], [54-58], [60-64], [66], [70][71][72][73][74][75][76][77][78][79][80][81], [84][85][86][87][88], [90][91][92][93], [95][96][97][98][99][100][101][102][103].…”

Section: Resultsmentioning

confidence: 99%

“…[55], [64], [64], [66], [71], [73], [74], [78], [90]- [93]. TPN allows for a faster reduction in pleural effusion [83].…”

Section: Resultsmentioning

confidence: 99%

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Knop

Kochanowska

Piasecka

et al. 2022

J Educ Health Sport

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Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe. The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.

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“…3%) [ 6 , 7 ]. In regards to non-surgical traumatic events, a few reports suggest injury to the thoracic duct due to elevated intrathoracic pressure after severe episodes of vomiting, coughing or delivery maneuvers [ 8 , 9 ]. Non-traumatic causes include malignancies, most commonly lymphoma [ 5 , 7 ], infectious diseases such as tuberculosis or others including subclavian vein thrombosis and lymphatic anomalies (Fig.…”

Section: Introductionmentioning

confidence: 99%

Cough-induced chylothorax in a two-year-old boy – case report and review of the literature

Anger,

Hofmann,

Ruf

et al. 2023

BMC Pediatr

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Background Chylothorax is a very rare form of pleural effusion in children, especially after the neonatal period, and predominantly occurs secondary to cardiothoracic surgery. It can lead to significant respiratory distress, immunodeficiency, and malnutrition. Effective treatment strategies are therefore required to reduce morbidity. Case presentation A previously healthy two-year old boy was admitted with history of heavy coughing followed by progressive dyspnea. The chest X-ray showed an extensive opacification of the right lung. Ultrasound studies revealed a large pleural effusion of the right hemithorax. Pleural fluid analysis delivered the unusual diagnosis of chylothorax, most likely induced by preceded excessive coughing. After an unsuccessful treatment attempt with a fat-free diet and continuous pleural drainage for two weeks, therapy with octreotide was initiated. This led to complete and permanent resolution of his pleural effusion within 15 days, without any side effects. Conclusions Severe cough may be a rare cause of chylothorax in young children. Octreotide seems to be an effective and safe treatment of spontaneous or traumatic chylothorax in children. There is, however, a lack of comprehensive studies for chylothorax in children and many issues concerning diagnostic strategies and treatment algorithms remain.

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Bilateral spontaneous chylothorax after severe vomiting in children

Cited by 6 publications

References 15 publications

Infected chylothorax: a case report and review

Infected chylothorax: a case report and review

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Cough-induced chylothorax in a two-year-old boy – case report and review of the literature

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