Pleuroperitoneal Shunt for Chylothorax and Chylopericardium in Lung Cancer: A Case Report

Shimmyo, Takuo; Morita, Katsusada; Mineshita, Masamichi; Tagaya, Rie; Ando, Koji; Kurimoto, Noriaki; Miyazawa, Teruomi; Osada, Hiroaki; Nakamura, Hiroki

doi:10.5761/atcs.cr.09.01482

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…Another increasingly popular therapeutic option that might also be offered to patients with unexpandable lung is chest tube insertion to permanently drain the pleural fluid (indwelling or tunneled pleural catheter, IPC). Pleuro-peritoneal [12] or pleuro-venal [13, 14] shunts are hardly ever used anymore, because of the invasive character of the procedure and the high complication rate. With IPC, symptomatic relief can be achieved in 70–94.2% patients with MPE [15, 16].…”

Section: Background and Clinical Aspects Of Pleurodesismentioning

confidence: 99%

Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration

et al. 2019

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Chemical pleurodesis is a therapeutic procedure applied to create the symphysis between the parietal and visceral pleura by intrapleural administration of various chemical agents (e.g. talk, tetracycline, iodopovidone, etc.). The two major clinical conditions treated with chemical pleurodesis are recurrent pleural effusion (PE) and recurrent spontaneous pneumothorax. Although the history of chemical pleurodesis began over a century ago, detailed data on the mechanisms of action of sclerosing agents are highly incomplete. The following article aims to present the state of knowledge on this subject.It is believed that mesothelial cells are the main structural axis of pleurodesis. In response to sclerosing agents they secrete a variety of mediators including chemokines such as interleukin 8 (IL-8) and monocyte chemoattractant protein (MCP-1), as well as growth factors - vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and transforming growth factor- β (TGF-β). Numerous data suggest that intact mesothelial cells and the above cytokines play a crucial role in the initiation and maintenance of different pathways of pleural inflammation and pleural space obliteration.It seems that the process of pleurodesis is largely nonspecific to the sclerosant and involves the same ultimate pathways including activation of pleural cells, coagulation cascade, fibrin chain formation, fibroblast proliferation and production of collagen and extracellular matrix components. Of these processes, the coagulation cascade with decreased fibrinolytic activity and increased fibrinogenesis probably plays a pivotal role, at least during the early response to sclerosant administration.A better understanding of various pathways involved in pleurodesis may be a prerequisite for more effective and safe use of various sclerosants and for the development of new, perhaps more personalized therapeutic approaches.

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Section: Background and Clinical Aspects Of Pleurodesismentioning

confidence: 99%

Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration

et al. 2019

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“…Pleurodesis has been used as an adjunct to TD ligation or in addition to fibrin glue when the site of the injury could not be identified (14). Pleuroperitoneal shunts are useful equipment in the armamentaria for managing chylothorax but are more often inserted for patients with refractory chylothorax from non-stab causes (16,17).…”

Section: Discussionmentioning

confidence: 99%

Traumatic chylothorax from a suprascapular stab wound

Oyebanji¹,

Ahmad²,

Inuwa³

2020

Ann Afr Surg.

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“…Chemical pleurodesis may also be considered in cases not responding to conservative therapy ( 20 , 21 ), and in refractory cases, thoracic duct ligation can be done via open thoracotomy or video-assisted thoracoscopic surgery ( 22 ). Thoracic duct embolization is also an option, but it is technically challenging ( 23 ) and lastly, for those patients who fail conservative treatment pleuroperitoneal shunt can be performed as a palliative procedure ( 24 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication

Bhattarai¹,

Schmidt²,

Devkota³

et al. 2015

Journal of Community Hospital Internal Medicine Perspectives

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Obstruction of the thoracic duct may lead to accumulation of a lymphatic fluid rich in triglycerides named chyle. When chyle accumulates in the pleural cavity, it becomes a chylothorax. Malignancy, particularly lymphoma, is the most common cause of chylothorax; however, any pathology leading to obstruction or destruction of the thoracic duct can lead to a chylothorax. This particular case investigates an incidence of chylothorax in sarcoidosis. A 54-year-old African American woman with a medical history of sarcoidosis, congestive heart failure, and smoking presented to the emergency department with complaints of bilateral foot swelling and exertional shortness of breath 3 days in duration. Physical examination was positive for bilateral crepitations with decreased air entry, abdominal ascites, and bilateral 2+ pitting edema. Both chest X-ray and chest CT were positive for stable bilateral pleural effusions (when compared to imaging done 3 years previously), and thoracocentesis and paracentesis were positive for chylous fluid accumulation. Chylothorax was diagnosed, and based on the previous medical history, the lymphadenopathy of sarcoidosis was determined to cause the occlusion of the thoracic duct. Lymphoscintigraphy and surgical intervention were advised; however, the family decided on conservative management and the patient expired intubated in the ICU. Chylothorax is a rare manifestation of sarcoidosis and high index of suspicion should be there to diagnose this, as there is high morbidity and mortality associated with it.

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Pleuroperitoneal Shunt for Chylothorax and Chylopericardium in Lung Cancer: A Case Report

Cited by 11 publications

References 8 publications

Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration

Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration

Traumatic chylothorax from a suprascapular stab wound

A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication

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