Management of Spontaneous Congenital Chylothorax: Oral Medium-Chain Triglycerides Versus Total Parenteral Nutrition

Alvarez, J R Fernández; Kalache, Karim; Grauel, E. L.

doi:10.1055/s-1999-6816

Cited by 66 publications

(21 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…O'Callaghan and Mead (1995), however, presented four cases of lymphoma-associated chylothorax and concluded that although malignant lymphoma can be treated effectively, chylothorax requires additional treatment. We made no surgical or other interventions, including nil by mouth (Fernandez Alvarez et al 1999) or octreotide administration (Al-Zubairy & Al-Jazairi 2003). Six of 11 malignant lymphoma patients entered complete remission after treatment.…”

Section: Discussionmentioning

confidence: 99%

Malignancy-associated chylothorax: a 20-year study of 18 patients from a single institution

Chen

et al. 2012

European Journal of Cancer Care

View full text Add to dashboard Cite

Malignancy-associated chylothorax is a rare manifestation with uncertain characteristics and clinical significance. We segregated 18 patients into malignant lymphoma (n= 11) and solid malignancy (n= 7) groups to analyse the characteristics, treatment response and prognostic value of malignancy-associated chylothorax. Diagnosis of chylothorax was confirmed by a triglyceride concentration of >110 mg/dL or by the presence of chylomicrons in the pleural effusion. Concentrations of glucose, protein and lactate dehydrogenase did not differ significantly between the malignant lymphoma and solid malignancy groups. Although not statistically significant (P= 0.25), 90.9% malignant lymphoma patients and 57.1% solid malignancy patients had exudates. The cytology diagnostic rate in the malignant lymphoma and solid malignancy groups was 20.0% and 33.3% respectively (P > 0.99). After chemotherapy, six malignant lymphoma patients achieved complete remission, with simultaneous chylothorax disappearance. The overall survival rate at 12 and 24 months in the malignant lymphoma group was 54.5% and 36.4% respectively, while that in the solid malignancy group was 35.7% and 0% respectively. Malignant lymphoma was the chief cause of chylothorax in our cohort. Effective lymphoma treatment, lacking supplementary interventions, is essential for treating chylothorax in malignant lymphoma patients. Chylothorax indicates extremely limited life expectancy for solid malignancy patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Malignancy-associated chylothorax: a 20-year study of 18 patients from a single institution

Chen

et al. 2012

European Journal of Cancer Care

View full text Add to dashboard Cite

show abstract

“…Treatment of a chylothorax involves insertion of intercostal chest catheters and nutrient replacement. Administration of low-fat medium chain triglycerides or nil by mouth settles 50% of traumatic chylothoraces 11. Medium chain triglycerides do not get absorbed into the lymphatic system, they are directly absorbed into the portal circulation.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal metastasectomy from a primary germ cell testicular tumour resulting in occult thoracic duct injury and chylothorax

Ali¹,

Wang

Larbalestier

2018

BMJ Case Reports

View full text Add to dashboard Cite

A 22-year-old man underwent mediastinal metastasectomy for a testicular germ cell tumour via median sternotomy. Intraoperatively, the tumour was massive, measuring 88 mm in anterior-posterior (AP) diameter. It was densely adherent to the trachea and aggressive debulking resulted in tracheal injury. Therefore, the patient was kept nil by mouth for 3 days postoperatively and was discharged uneventfully. He represented only 2 days later with a large right-sided chylothorax. His chylothorax was managed conservatively with insertion of an intercostal catheter (ICC) and a low-fat diet. Over the course of 9 days, the ICC drained approximately 5 L of fluid. His admission was further complicated by severe gastroparesis requiring feeding Nasojejunal (NJ) tube placement. The delayed feeding in this case resulted in late detection of the occult thoracic duct injury. This case illustrates that conservative and multidisciplinary management of a postoperative chylothorax from a suspected thoracic duct injury achieves favourable outcomes avoiding further surgical intervention.

show abstract

“…In 50% of the cases, non-surgical treatment for 10 to 14 days cured the disease [17]. If the conservative treatment fails so much that the drainage has accelerated in daily output to 200 to 500 mL per day for 1 to 3 weeks, it may be possible to consider an operative technique such as thoracic duct ligation or thoracic duct embolization.…”

Section: Discussionmentioning

confidence: 99%

Delayed right chylothorax after left blunt chest trauma: a case report

et al. 2017

View full text Add to dashboard Cite

BackgroundChylothorax is a disease that has various causes such as neoplasm, infection, post-surgery trauma, congenital, and venous thrombosis. In approximately 15% of cases of chylothorax, the exact cause is unknown. We report a case of delayed occurrence of right chylothorax in a patient who had multiple segmental ribs fracture on his left side.Case presentationA 70-year-old Asian man had a “rollover” accident in which the cultivator he was driving overturned. He presented to our hospital with the main complaint of severe dyspnea. On chest computed tomography, multiple ribs fracture from the first to the eighth rib of the left side of his chest and left-sided hemopneumothorax were presented, but there was no evidence of fracture in the right side of his chest.After closed thoracostomy, an emergency operation for open reduction of fractured ribs was performed. On the fifth postoperative day, tubal feeding was performed. On the next day, a plain chest X-ray image showed pleural effusion of the right side of his chest. After insertion of a small-bore chest tube, 3390 ml of fluid for 24 hours was drained. The body fluid analysis revealed triglycerides levels of 1000 mg/dL, which led to a diagnosis of chylothorax. Although non-oral feeding and total parenteral nutrition were sustained, drain amount was increased on the fifth day. Surgical treatment (thoracoscopic thoracic duct ligation and pleurectomy) was performed in the early phase. The right chest tube was removed on the 14th postoperative day after the effusion completely resolved and he was uneventfully discharged.ConclusionsIn this case, as our patient was in old age and had multiple traumas, surgical treatment for chylothorax needed to be performed in the early phase.

show abstract

Management of Spontaneous Congenital Chylothorax: Oral Medium-Chain Triglycerides Versus Total Parenteral Nutrition

Cited by 66 publications

References 29 publications

Malignancy-associated chylothorax: a 20-year study of 18 patients from a single institution

Malignancy-associated chylothorax: a 20-year study of 18 patients from a single institution

Mediastinal metastasectomy from a primary germ cell testicular tumour resulting in occult thoracic duct injury and chylothorax

Delayed right chylothorax after left blunt chest trauma: a case report

Contact Info

Product

Resources

About