Spontaneous Chylothorax following Septic Pulmonary Embolization

Agustin, Michael; Yamamoto, Michele; Tongma, Chawat; Chua, Leslie Anne; Torres, Michael; Shay, Scott

doi:10.1155/2020/3979507

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Chylothorax is nearly always exudative. The incidence of the exudative condition in our chylothorax patient accounts for 84.17%, which is consistent with previous reports [10,32]. Transudative chylothorax is extremely rare and mostly is associated with hepatic cirrhosis, nephrotic syndrome, amyloidosis, and obstruction of the superior vena cava [11,[33][34][35].…”

Section: Discussionsupporting

confidence: 92%

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

Zhang

Wang

et al. 2023

EJNMMI Res

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Background Chylothorax is a condition that can be challenging to diagnose due to its nonspecific clinical presentation. Several biochemical parameters of chylous pleural effusion have been identified as important indicators for the diagnosis of chylothorax. Lymphoscintigraphy is utilized to assess chylothorax and determine the location of chyle leakage. The present study aimed to evaluate the correlation between the biochemical parameters of chylous pleural effusion and 99mTc-dextran (99mTc-DX) lymphoscintigraphy in diagnosing chylothorax. Material and methods A total of 120 patients were enrolled in the study, 83 of the patients with unilateral chylothorax, and 37 with bilateral chylothorax. All patients underwent both 99mTc-DX lymphoscintigraphy and pleural effusion laboratory analysis. The 99mTc-DX lymphoscintigraphy images were categorized as positive or negative groups based on the presence or absence of abnormal radioactive tracer accumulation in the thorax, respectively. The biochemical parameters of the two groups were subsequently compared. Results Among these patients, 101 (84.17%) had exudative effusions, while 19 (15.83%) had transudative effusions, as determined by the levels of pleural effusion protein, lactate dehydrogenase and cholesterol. Abnormal tracer accumulation in thorax was observed in 82 patients (68.33%). Our findings indicated that lymphoscintigraphy results were not associated with exudative and transudative chylothorax (P = 0.597). The lymphoscintigraphy positive group displayed significantly higher levels of pleural effusion triglyceride and pleural effusion triglyceride/serum triglyceride ratio in all biochemical parameters, compared to the negative group (P = 0.000 and P = 0.005). We identified cutoff values of 2.870 mmol/L for pleural effusion triglycerides and 4.625 for pleural effusion triglyceride/serum triglyceride ratio, respectively, which can facilitate differentiating the positive and negative cases on lymphoscintigraphy. Conclusion Lymphoscintigraphy technique is a dependable diagnostic tool for the qualitative assessment of chylous pleural effusion. Higher pleural effusion triglyceride level and pleural effusion triglyceride/serum triglyceride ratio indicate a positive result in patients with chylothorax on lymphoscintigraphy, with the cutoff values of 2.870 mmol/L and 4.625 aiding in the diagnosis.

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Section: Discussionsupporting

confidence: 92%

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

Zhang

Wang

et al. 2023

EJNMMI Res

View full text Add to dashboard Cite

show abstract

“…Chylothorax is nearly always exudative. The incidence of the exudative condition in our chylothorax patient accounts for 84.17%, which is consistent with previous reports [11,35]. Transudative chylothorax is extremely rare, and mostly is associated with hepatic cirrhosis, nephrotic syndrome, amyloidosis, and obstruction of the superior vena cava [12,36,37].…”

Section: Discussionsupporting

confidence: 91%

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

Zhang

Wang

et al. 2023

Preprint

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Background Chylothorax is a condition that can be challenging to diagnose due to its nonspecific clinical presentation. Several biochemical parameters of chylous pleural effusion have been identified as important indicators for the diagnosis of chylothorax. Lymphoscintigraphy, a non-invasive imaging technique, is also used to evaluate chylothorax and determine the location of chyle leakage. This study aimed to evaluate the correlation between the biochemical parameters of chylous pleural effusion and 99mTc-dextran (DX) lymphoscintigraphy in diagnosing chylothorax. Material and methods A total of 120 patients were enrolled, 83 of the patients had unilateral chylothorax, and 37 had bilateral chylothorax. All patients conducted both 99mTc-DX lymphoscintigraphy and pleural effusion laboratory analysis. The images were classified into positive and negative groups based on whether an abnormal accumulation of the radioactive tracer was observed in the thorax on 99mTc-DX lymphoscintigraphy. And the biochemical parameters of the two groups were compared. Results Among these patients, 101 (84.17%) had exudative effusions, and 19 (15.83%) had transudative effusions, according to the levels of pleural effusion protein, lactate dehydrogenase and cholesterol. Abnormal tracer accumulation in thorax was observed in 83 patients (69.17%). Exudative and transudative chylothorax are not associated with lymphoscintigraphy results (P = 0.597). In all biochemical parameters, lymphoscintigraphy positive group had significantly higher levels of pleural effusion triglyceride and pleural effusion triglyceride/serum triglyceride ratio compared with negative group (P = 0.000 and P = 0.005). The cutoff values that we identified for pleural effusion triglycerides and pleural effusion triglyceride/serum triglyceride ratio were 2.870 mmol/L and 4.625, respectively, which can facilitate differentiating the positive and negative results on lymphoscintigraphy. Conclusion Lymphoscintigraphy technique is a reliable diagnostic tool for the qualitative evaluation of chylous pleural effusion. Higher pleural effusion triglyceride level and pleural effusion triglyceride/serum triglyceride ratio indicate a positive result in patients with chylothorax on lymphoscintigraphy, and the cutoff values of 2.870 mmol/L and 4.625 can help with the diagnosis.

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A challenging coexistence: community-acquired methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis

Afşin,

Sümbül,

Gülözer

2024

Egypt J Bronchol

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Background Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) usually emerges after a viral infection and causes severe disease in immunocompetent individuals. Concurrent infection with tuberculosis (TB) is generally very rare in immunocompetent patients. Our case is the first report of the coexistence of CA-MRSA and TB in an immunocompetent patient. Case presentation A 24-year-old male patient of African origin, who has been living in Turkey for a year, was admitted to our hospital 3 months ago with fever, cough, and sputum complaints, which developed following symptoms of influenza infection. More intense bilateral infiltration and cavitary appearance were observed on the left in the chest radiography of the patient who did not respond to amoxicillin and gemifloxacin treatments. The patient’s sputum culture showed MRSA growth, and his sputum acid-resistant bacteria (ARB) was reported as three positive. Vancomycin, isoniazid, rifampicin, pyrazinamide, and ethambutol treatments were started. Subsequently, Mycobacterium Tuberculosis growth was also detected in the mycobacteria culture. Vancomycin treatment was completed in 14 days. There was no growth in the control sputum culture. When the patient, who gave clinical and laboratory response, was admitted with increased shortness of breath complaint two months after discharge, it was observed that minimal spontaneous pneumothorax developed in the left lung, and it was decided to follow up without intervention. In the second month of tuberculosis treatment, sputum ARB and mycobacteria culture became negative, and the patient was switched to dual antituberculosis treatment (isoniazid, rifampicin), and his treatment is still ongoing. Conclusions Mixed infections should be considered in case of non-response to treatment in patients with pneumonia. Mixed infections should also be followed closely as they may be more complicated.

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Spontaneous Chylothorax following Septic Pulmonary Embolization

Cited by 3 publications

References 9 publications

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

A challenging coexistence: community-acquired methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis

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