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Spilt Milk: An Unusual Cause of Bilateral Chylothorax.

Matani S, Pierce JR - J Investig Med High Impact Case Rep (2015)

Bottom Line: Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics.Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy.Our patient was effectively treated by conservative management.

View Article: PubMed Central - PubMed

Affiliation: University of New Mexico School of Medicine, Albuquerque, NM, USA.

ABSTRACT
We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray 1 week after the surgery, interpreted as bilateral basilar atelectasis. Staples over the left thorax are a result of left pectoralis major pedicled myocutaneous flap reconstruction.
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fig1-2324709615583877: Chest X-ray 1 week after the surgery, interpreted as bilateral basilar atelectasis. Staples over the left thorax are a result of left pectoralis major pedicled myocutaneous flap reconstruction.

Mentions: Seven days after the surgery, the patient developed dyspnea and hypoxemia with an oxygen saturation by pulse oximetry of 82% on room air. Examination revealed dullness to percussion and decreased breath sounds at both lung bases. Chest X-ray was interpreted as showing bilateral basilar atelectasis (Figure 1). Computed tomography of the chest revealed bilateral pleural effusions (Figure 2).


Spilt Milk: An Unusual Cause of Bilateral Chylothorax.

Matani S, Pierce JR - J Investig Med High Impact Case Rep (2015)

Chest X-ray 1 week after the surgery, interpreted as bilateral basilar atelectasis. Staples over the left thorax are a result of left pectoralis major pedicled myocutaneous flap reconstruction.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528870&req=5

fig1-2324709615583877: Chest X-ray 1 week after the surgery, interpreted as bilateral basilar atelectasis. Staples over the left thorax are a result of left pectoralis major pedicled myocutaneous flap reconstruction.
Mentions: Seven days after the surgery, the patient developed dyspnea and hypoxemia with an oxygen saturation by pulse oximetry of 82% on room air. Examination revealed dullness to percussion and decreased breath sounds at both lung bases. Chest X-ray was interpreted as showing bilateral basilar atelectasis (Figure 1). Computed tomography of the chest revealed bilateral pleural effusions (Figure 2).

Bottom Line: Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics.Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy.Our patient was effectively treated by conservative management.

View Article: PubMed Central - PubMed

Affiliation: University of New Mexico School of Medicine, Albuquerque, NM, USA.

ABSTRACT
We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula.

No MeSH data available.


Related in: MedlinePlus