Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

Abstract

One year following pain onset, she began to present paresis of the right hand. The patient was depressed, having been under psychiatric treatment for seven years. Physical examination presented cervical muscle contracture, palmar muscle atrophy with weakened grasp movement and sensory alteration in the same region. The results of Adson's test, military posture and Ross test were positive. The patient was therefore diagnosed with a clinical profile consistent with thoracic outlet syndrome.Electroneuromyography revealed decreased amplitudes in the sensory conduction of the right ulnar nerve, as well as in the motor conduction of the right ulnar and median nerves, conduction block of the right ulnar nerve at elbow level and reinnervation at the C8-T1 level. The motor conduction speed of the right ulnar nerve was 66.7 m/s below elbow level and 47.6 m/s above elbow level.A Doppler ultrasound of the elevated right upper limb revealed significant compression of IntroductionThe supraclavicular approach to surgical treatment of thoracic outlet syndrome is frequently used, since it presents a high rate of therapeutic success and a low risk of complications.(1,2) Brachial plexus lesion and vascular lesions are the most frequent complications. (1,(3)(4)(5) Chylothorax as a complication of this surgical procedure is rare, (6,7) and, if occurring, is normally left-sided.(8) Its incidence ranges from 0.25% to 0.5%, even in general thoracic surgery.(8) Here, we report a case of chylothorax occurring after resection of a right cervical rib and of the right first rib. The chylothorax was successfully treated through an additional surgical procedure. Case reportA 25-year-old female patient, a seamstress having worked in a shoe factory for seven years, was referred to our facility for investigation of a two-year history of progressive pain in the right wrist, accompanied by local paresthesia. AbstractChylothorax as a complication of the surgical treatment of thoracic outlet syndrome is a quite rare event. We report a case of right-sided chylothorax and present a brief review on the treatment of postoperative chylothorax.Keywords: Chylothorax; Thoracic outlet syndrome; Cervical rib syndrome; Postoperative complications. ResumoA fístula linfática como complicação de correção de síndrome do desfiladeiro torácico é um evento muito raro. Relatamos um caso de fístula linfática à direita e apresentamos uma breve revisão do tratamento de quilotórax pós-cirúrgico.Descritores: Quilotórax; Síndrome do desfiladeiro torácico; Síndrome da costela cervical; Complicações pós-operatórias.

Morphological evaluation of the thoracic, lumbar and sacral column of the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758)

“…These ribs receive this nomenclature because they are present in cervical vertebrae. In humans, the presence of these ribs is one of the causes of thoracic outlet syndrome (SDT) (Silvestri et al 2005, Araújo et al 2009). Farrow (2005) describes the cranial lumbarization process, which occurs when the last thoracic vertebra assumes the characteristics of the first lumbar vertebra and may result in the loss of one or two ribs or present one or two hypoplastic ribs, which may explain the presence of floating ribs in the animals of this study.…”

Síndrome Do Desfiladeiro Torácico: Uma Revisão Integrativa

“…Um estudo demonstra que 60% dos pacientes permaneceram incapacitados e incapazes de continuar as atividades necessárias ao trabalho em um ano após a intervenção cirúrgica (LUM et al, 2012;THOMAZINHO et al, 2008). Araujo et al, (2009) descreve que uma das principais complicações da cirurgia tem sido a lesão do nervo frênico e que normalmente regride em três meses na maioria dos casos. Outras complicações que relatam são as lesões da veia e artéria subclávias.…”

Síndrome do desfiladeiro torácico - ressecção de costela cervical por videotoracoscopia

“…Com a experiência adquirida previamente por um dos cirurgiões (MCG) na ressecção de primeira costela por VATS em mais de 20 pacientes, optamos por essa via de acesso para ressecar também a costela cervical. Potenciais complicações dessa abordagem poderiam ser quilotórax 14 , parestesias 15 , lesões inadvertidas de plexo braquial, nervos ou vasos subclávios e pneumotórax persistente 16 . A potencial vantagem do método é, sem dúvida, a magnificação da imagem, permitindo assim identificar muito bem as estruturas normais e anômalas, tão frequentes nesta afecção, assim como a posição do braço, que permanece relaxado durante toda a operação, pois não há necessidade de tração, como nos casos de abordagem transaxilar.…”