Intrapleural Streptokinase for the Treatment of Chylothorax

Kuan, Yeh Chunn; How, Soon Hin; Ng, Teck Han; Rani, Mohammed Fauzi Abdul

doi:10.4187/respcare.01207

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…The role of fibrinolytics is not established but has been proposed for patients with idiopathic chylothorax who failed conservative therapy but refused surgery in one case report [9]. There were very limited case reports on the successful use of fibrinolytics for idiopathic chylothorax and empyematous multiloculated chylothorax [3,9]. In conclusion, we report a rare case of nontraumatic, nonmalignant, and nontuberculous chylothorax which was considered a complication of severe pulmonary septic embolization that likely damaged the pulmonary lymphatic drainage.…”

Section: Discussionmentioning

confidence: 89%

“…Since our repeat CT of the chest showed evidence of loculated pleural fluid, two (2) doses of Alteplase were instilled intrapleurally. The role of fibrinolytics is not established but has been proposed for patients with idiopathic chylothorax who failed conservative therapy but refused surgery in one case report [9]. There were very limited case reports on the successful use of fibrinolytics for idiopathic chylothorax and empyematous multiloculated chylothorax [3,9].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Chylothorax following Septic Pulmonary Embolization

Agustin

Yamamoto

Tongma

et al. 2020

Case Reports in Pulmonology

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Chylothorax is the occurrence of chyle (lymph) in the pleural cavity secondary to damage of the thoracic duct. It is a rare form of pleural effusion which appears as a milky white turbid fluid. Malignancy is the leading cause of nontraumatic chylothorax while inadvertent surgical injury to the thoracic duct is the major cause of traumatic chylothorax. We report a case of spontaneous left-side chylothorax following septic pulmonary embolization (SPE) with Methicillin-Resistant Staphylococcus aureus (MRSA). This is a rare case of a nonmalignant, nontraumatic, and nontuberculous spontaneous chylothorax which was conservatively treated with fibrinolysis and diet modification.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Spontaneous Chylothorax following Septic Pulmonary Embolization

Agustin

Yamamoto

Tongma

et al. 2020

Case Reports in Pulmonology

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“…The injection of OK-432, which is a heat- and penicillin-treated lyophilized preparation of the Su strain of Streptococcus pyogenes, into the thoracic cavity is effective and safe in managing postoperative chylothorax and exhibited a success rate of 87% [12]. Other therapeutic options such as the intrapleural instillation of octreotide/somatostatin, streptokinase or fibrin glue therapy were only published as case reports [18,21,22]. …”

Section: Discussionmentioning

confidence: 99%

Radiotherapy in the treatment of postoperative chylothorax

Sziklavári

Allgäuer

Hübner

et al. 2013

J Cardiothorac Surg

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BackgroundChylothorax is characterized by the presence of chyle in the pleural cavity. The healing rate of non-operative treatment varies enormously; the maximum success rate in series is 70%. We investigate the efficacy and outcomes of radiotherapy for postoperative chylothorax.MethodsChylothorax was identified based on the quantity and quality of the drainage fluid. Radiation was indicated if the daily chyle flow exceeded 450 ml after complete cessation of oral intake. Radiotherapy consisted of opposed isocentric portals to the mediastinum using 15 MV photon beams from a linear accelerator, a single dose of 1–1.5 Gy, and a maximum of five fractions per week. The radiation target area was the anatomical region between TH3 and TH10 depending on the localization of the resected lobe. The mean doses of the ionizing energy was 8.5 Gy ± 3.5 Gy.ResultsThe median start date of the radiation was the fourth day after chylothorax diagnosis. The patients’ mediastinum was radiated an average of six times. Radiotherapy, in combination with dietary restrictions, was successful in all patients. The median time between the end of the radiation and the removal of the chest tube was one day. One patient underwent wound healing by secondary intention. The median time between the end of radiation and discharge was three days, and the overall hospital stay between the chylothorax diagnosis and discharge was 18 days (range: 11–30 days). After a follow-up of six months, no patient experienced chylothorax recurrence.ConclusionsOur results suggest that radiotherapy in combination with dietary restriction in the treatment of postoperative chylothorax is very safe, rapid and successful. This novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays and could be the first choice in the treatment of postthoracotomy chylothorax.

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“…Although there are several decades of experience in using tPA (or other serine proteases) for clogged pleural tubes and loculated pleural effusions, the instillation of tPA into a clogged pericardial drain for chylous effusion as described by Delany and colleagues is novel. [1][2][3][4] Chyle leaks after cardiac surgery in neonates and infants occur in up to 9% of cases. 5 The exact incidence of clogged pericardial tubes secondary to chylous drainage after pediatric cardiac surgery is not known.…”

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confidence: 99%