“Nutrition or no nutrition?”: Chylothorax or leakage of total parenteral nutrition?

Zasada, Inga Alicja; Banner, Jytte; Bugge, Anne

doi:10.1007/s12024-019-00113-6

Cited by 9 publications

(5 citation statements)

References 3 publications

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“…Alternatively, many milky effusions initially suspicious for chylopericardium were found to be CVC-infused TPN in the pericardial space [ 9 ]. CVC-related pericardial effusion with tamponade occurs in 1–3% of neonates, with a 30–50% mortality [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Thornhill,

Fortuna,

Canteras

et al. 2023

Journal of Surgical Case Reports

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Cardiac tamponade is a known life-threatening complication of extracorporeal membrane oxygenation (ECMO), often secondary to hemopericardium from major vascular or cardiac perforation. We present the unique case of a neonate with a milky pericardial effusion causing tamponade after ECMO cannulation, managed successfully with pericardial window. Understanding ECMO physiology and its effect on the classic presentation of tamponade is critical and can prevent delays in diagnosis. While hemopericardium is most commonly seen in these cases, findings of a non-bloody, milky effusion should prompt further workup for infection, chylopericardium or total parenteral nutrition-associated pericardial effusion, as the appropriate management can mitigate immediate and potential long-term sequelae.

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Section: Discussionmentioning

confidence: 99%

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Thornhill,

Fortuna,

Canteras

et al. 2023

Journal of Surgical Case Reports

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“…Our patient had no such intervention making it a unique case 9–12. Diagnosis of chylothorax is suspected on encountering milky looking pleural effusion, but it is important to realise that the differential diagnosis can also include empyema, cholesterol effusion, inadvertent infusion of propofol into the pleural cavity or inadvertent infusion of total parentral nutrition (TPN) into the pleural cavity 14–16. The diagnosis is made with fluid analysis, a TG level with a threshold of >110 mg/dL is commonly used to define chylothorax 17.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax as a complication of extensive spontaneous left arm DVT

2019

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We present a case of right sided chylothorax in the setting of cirrhosis believed to be secondary to extensive venous thromboembolism of the left upper extremity and exacerbated by chylous ascites. Our patient responded to conservative management with anticoagulation and a repeat thoracentesis revealed transformation of the fluid back to straw coloured transudate. We also include a brief discussion of the diagnosis and management of chylothorax.

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“…In addition, chylous PEs are inodorous, while anaerobic empyemas are foul-smelling in over half the cases. The whitish appearance of PF is rarely due to the leakage of an enteral nutrition formula from a central catheter into the pleural space (nutrithorax) 8 .…”

Section: Macroscopic Appearance Of Pfmentioning

confidence: 99%

Pleural fluid biochemistry: A first step toward an etiological diagnosis of pleural effusions

Porcel¹

2021

SJMED

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The analysis of pleural fluid (PF) is the most important diagnostic element in identifying the cause of pleural effusions. PF biochemistries, in particular, are available immediately and offer relevant clinical information. The measurement of proteins and lactate dehydrogenase (LDH) in PF and blood (Light's criteria) establishes the transudative or exudative nature of effusions. Transudates are commonly caused by heart failure (HF), but diuretic therapy may concentrate PF causing higher levels of protein and/or LDH and, therefore, leading to a misclassification as an exudate. In this scenario, a serum-PF albumin gradient > 1.2 g/dL points to a true transudate. Furthermore, elevated concentrations of the natriuretic peptide N-terminal pro-brain natriuretic peptide are virtually pathognomonic of HF as the primary or, at least, secondary diagnosis. In exudates with predominantly polymorphonuclear leukocytes (> 50%), a bacterial infection of the pleural space should be considered, particularly if PF C-reactive protein levels are high. A pleural pH < 7.15 or a glucose < 40 mg/dL in a parapneumonic effusion indicates the need for a drainage tube. When lymphocytes predominate in an exudate, cancer and tuberculosis are the two main diagnoses to consider; an adenosine deaminase activity > 35 U/L strongly supports the diagnosis of tuberculosis. Measuring tumor markers (e.g., carcinoembryonic antigen, CA15-3) under the premise of using 100% specific cutoff points can increase the diagnostic yield for malignancy.

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“Nutrition or no nutrition?”: Chylothorax or leakage of total parenteral nutrition?

Cited by 9 publications

References 3 publications

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Milky pericardial effusion causing tamponade in a neonate after extracorporeal membrane oxygenation cannulation

Chylothorax as a complication of extensive spontaneous left arm DVT

Pleural fluid biochemistry: A first step toward an etiological diagnosis of pleural effusions

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