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The Extra-Pleural and Pleural Spaces, including Plombages, Pleural Tumours and the Effects of Asbestos.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
(c) Venous obstruction may also lead to secondary lymphatic obstruction. A chylothorax may also lead to secondary lymphatic obstruction. A chylothorax has been found to be a complication of SVC thrombosis in both clinical and experimental studies (see references below). It may also occur as a complication of thrombosis around central venous catheters. The mechanism of a chylothorax being caused by venous obstruction appears to be mediastinal swelling, as ligation of the SVC in animals causes the mediastinal tissues and lymph nodes to become considerably congested with chylous fluid.
Cardiac Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Megan Horsley, Jeffrey Anderson
One complication or disorder that occurs in patients with CHD is chylothorax. Chylothorax is associated with increased mortality, hospital length of stay, intensive care unit length of stay, time on mechanical ventilation, extracorporeal membrane oxygenation use, and cost. This occurs when there is the presence of lymphatic fluid (chyle) in the pleural space caused by damage to the thoracic duct or lympho-venous connections or secondary to lymphatic abnormalities. It is often a result of iatrogenic complications of cardiothoracic surgery, commonly caused by trauma to the thoracic duct or other surrounding lymphatic tributaries. It has also been described in children with genetic syndromes associated with CHD, including trisomy 21, Noonan’s syndrome, Turner’s syndrome, and cardio-facio-cutaneous syndrome. Additionally, chylothorax can result from high central venous pressure within the superior vena cava (SVC), thereby affecting the pressure in the lymphatic system and inability of the lymphatic system to adequately drain into the bloodstream. This is seen mainly in operations that cause increased SVC pressure, such as the hemi-Fontan or bidirectional Glenn, Fontan, and Senning procedures, and can also be seen in patients with thrombus occluding the SVC or subclavian vessels.
Chylothorax
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
A chylothorax is a pleural effusion composed of lymphatic fluid. In children, the most common etiology is iatrogenic following an operation within the posterior mediastinum. Procedures on the esophagus and thoracic aorta, such as ligation of a patent ductus arteriosus, coarctation repair, and Fontan procedure, are at highest risk for this complication. Ten per cent of chylothoraces in the pediatric population are congenital. Other important causes of chylothoraces in children include superior vena cava obstruction, blunt and penetrating trauma, lymphatic malformations, malignancy, and following diaphragmatic hernia repair, particularly in the setting of right heart failure.
Chylothorax in Behçet’s disease
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Sophie B. Kermelly, Marie-Ève Boucher, François Côté, François Maltais
Chylothorax is managed with dietary fat restriction to medium-chain triglycerols to reduce the production of monoglycerides and free fatty acids circulating in the chyle.18 Attempting to reduce chyle accumulation in the pleural space is warranted to prevent denutrition and immunodepression related to the loss of lymphocytes present in the liquid. Failure of medical therapy of the underlying cause or recurrent effusions often necessitate surgical approaches such as thoracic drains, blood patch, tetracycline or talc pleurodesis, and ligature of the thoracic duct that have all been attempted with good short-term outcomes.14,19–21 Thoracic duct embolization is another interventional technique with good success rate, particularly in the context of traumatic chylothoraces.22 In our particular case, since the underlying pathophysiology of chylothorax formation was high venous pressure with a chyle backflow, the main therapeutic strategy was to prevent the formation of new thrombosis with anticoagulation and immunosuppression, hoping for repermeabilization of the superior vena cava to occur. It was also felt important to reduce the formation of chyle with the nutritional intervention. This combined therapy was successful in resolving our patient’s chylothorax without surgical management.
The effect of prophylactic thoracic duct ligation during esophagectomy on the incidence of chylothorax and survival of the patients: an updated review
Published in Postgraduate Medicine, 2021
Lei Liu, Longbo Gong, Miao Zhang, Wenbin Wu
There were several limitations that should be identified. First, there was only one RCT in the meta-analysis; thus, the results should be interpreted with caution as it might yield misleading information due to the significant heterogeneity, inherent bias, and limited sample size of the included reports. In addition to tumor stage and lymph node status of the patients, intraoperative thoracic duct injury might be an important indication during surgical decision-making of TDL. However, all these issues could not be obtained from the included reports. Second, non-English/non-Chinese relevant articles might be neglected. Third, the detection and diagnostic criteria of chylothorax varied in different studies. More importantly, the indications for TDL probably varied among the retrieved articles partly due to the lymph node status of the patients and the surgical experience/preference of the surgeons. Meanwhile, there are a lot of items correlated with the occurrence of chylothorax including but not limited to the variable anatomy of the thoracic duct and the extent/quality of mediastinal lymphadenectomy. Based on the currently available evidence, the actual benefit of TDL largely remains unanswered. Therefore, further well-designed multicenter trials are warranted to verify the exact effect of TDL during thoracic cancer surgery. In addition, preclinical researches for better understanding of the mechanisms of TDL-related harmful effect are also warmly welcomed.
A conservative approach to a thoracic duct injury caused by left subclavian vein catheterization
Published in Egyptian Journal of Anaesthesia, 2018
Vedran Premuzic, Ranko Smiljanic, Drazen Perkov
Thoracic duct, wide only 2–6 mm, transports lymph from the lower part of the body and mixing with fluids from intestines form a mixture called chyle and pours into venous circulation by sometimes multiple branches. Its variations are seen in more than one third of the population. Cisterna chyli is present in only 50% of humans, when absent, there are 2 or more lymph ducts. Clouse relationship with other structures leads of injury during operations, a main cause of traumatic duct injury. Other causes as malignancies and coronary artery bypass are not so common, especially injuries during catheter insertions (<1% of cases). Periprocedural central venous catheter complications are mostly related to pneumo or hematothorax, vascular injury and the catheter tip malposition and very rarely thoracic duct injury which is similar with our experiences. The rate of these complications is higher in patients with prior temporary or permanent central venous catheters on hemodialysis. Patients with chylothorax manifest with onsets of pleuritic pain or dyspnea caused by pleural effusions which can also be absent in cases with low flow chylothorax and manifest only as unspecific pleural effusions on chest X-rays [7].