Limits...
Traumatic chylothorax: A case report and review.

Sendama W, Shipley M - Respir Med Case Rep (2015)

Bottom Line: An 84-year-old lady presented to the emergency department after being found collapsed at home.Chylous drainage of 1l/24hr was observed.Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, South Tyneside District Hospital, Harton Lane, South Shields NE34 0PL, United Kingdom.

ABSTRACT
Chylothorax is a rare entity characterised by leakage of lymphatic fluid into the pleural cavity from the thoracic duct. We present a case of traumatic chylothorax following a traumatic fracture of the L1 vertebra. An 84-year-old lady presented to the emergency department after being found collapsed at home. She gave a preceding history of one day of diarrhoea. Chest X-ray showed a rightsided effusion. Drainage of the effusion yielded a cloudy, off-white fluid that settled in layers in the drainage container. Pleural fluid examination revealed a lymphocyte-rich transudate with high levels of cholesterol and triglycerides. CT imaging of the chest, abdomen and pelvis revealed an acute left sided pulmonary embolus, and a multisegment burst fracture of the L1 vertebra. The patient was anticoagulated for the pulmonary embolus. Conservative fracture management was advised. Chylous drainage of 1l/24hr was observed. Due to ongoing chylous leak the patient was commenced on a medium-chain fatty acid diet and octreotide. Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury. Spinal trauma can rarely cause disruption of the thoracic duct and chylothorax. Diagnosis of chylothorax hinges on the typically high triglyceride content of chylous fluid and the detection of chylomicrons where the triglyceride concentration is equivocal. Management options for persistently draining chylothorax are varied and range from non-invasive medical measures to radiological and surgical interventions (although the patient in the case we present was an unsuitable candidate for surgery). We discuss pertinent diagnostic testing and put forward possible medical management strategies for chylothorax.

No MeSH data available.


Related in: MedlinePlus

CT imaging demonstrating burst fracture of L1 vertebra.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4356050&req=5

fig2: CT imaging demonstrating burst fracture of L1 vertebra.

Mentions: Review of the history with family members revealed a history of falls prior to admission that the patient herself struggled to recall. CT imaging of the chest, abdomen and pelvis revealed no evidence of malignancy, an acute left sided pulmonary embolus, and a multisegment fracture of the anterior two-thirds of the L1 vertebra with no posterior column involvement and a small associated paravertebral mass [Fig. 2]. The patient was anticoagulated for the pulmonary embolus, and the opinion of the spinal surgeons was that the fracture was stable and that the patient should be mobilised as tolerated.


Traumatic chylothorax: A case report and review.

Sendama W, Shipley M - Respir Med Case Rep (2015)

CT imaging demonstrating burst fracture of L1 vertebra.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356050&req=5

fig2: CT imaging demonstrating burst fracture of L1 vertebra.
Mentions: Review of the history with family members revealed a history of falls prior to admission that the patient herself struggled to recall. CT imaging of the chest, abdomen and pelvis revealed no evidence of malignancy, an acute left sided pulmonary embolus, and a multisegment fracture of the anterior two-thirds of the L1 vertebra with no posterior column involvement and a small associated paravertebral mass [Fig. 2]. The patient was anticoagulated for the pulmonary embolus, and the opinion of the spinal surgeons was that the fracture was stable and that the patient should be mobilised as tolerated.

Bottom Line: An 84-year-old lady presented to the emergency department after being found collapsed at home.Chylous drainage of 1l/24hr was observed.Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, South Tyneside District Hospital, Harton Lane, South Shields NE34 0PL, United Kingdom.

ABSTRACT
Chylothorax is a rare entity characterised by leakage of lymphatic fluid into the pleural cavity from the thoracic duct. We present a case of traumatic chylothorax following a traumatic fracture of the L1 vertebra. An 84-year-old lady presented to the emergency department after being found collapsed at home. She gave a preceding history of one day of diarrhoea. Chest X-ray showed a rightsided effusion. Drainage of the effusion yielded a cloudy, off-white fluid that settled in layers in the drainage container. Pleural fluid examination revealed a lymphocyte-rich transudate with high levels of cholesterol and triglycerides. CT imaging of the chest, abdomen and pelvis revealed an acute left sided pulmonary embolus, and a multisegment burst fracture of the L1 vertebra. The patient was anticoagulated for the pulmonary embolus. Conservative fracture management was advised. Chylous drainage of 1l/24hr was observed. Due to ongoing chylous leak the patient was commenced on a medium-chain fatty acid diet and octreotide. Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury. Spinal trauma can rarely cause disruption of the thoracic duct and chylothorax. Diagnosis of chylothorax hinges on the typically high triglyceride content of chylous fluid and the detection of chylomicrons where the triglyceride concentration is equivocal. Management options for persistently draining chylothorax are varied and range from non-invasive medical measures to radiological and surgical interventions (although the patient in the case we present was an unsuitable candidate for surgery). We discuss pertinent diagnostic testing and put forward possible medical management strategies for chylothorax.

No MeSH data available.


Related in: MedlinePlus