Tuberc Respir Dis.  2012 Jan;72(1):59-62.

A Case of Chylothorax after Tube Thoracostomy

• Choi KU
• Kang GH
• Kim SH
• Seo HW
• Jung BH
• Kim SS
• Lim J

Abstract

Tube thoracostomy is known to cause complications such as bleeding or infection, but the incidence of chylothorax secondary to tube thoracostomy is under-reported, and therefore, we report this case. A patient was diagnosed as systemic lupus erythematosus with pleural and pericardial involvement. During repeated therapeutic thoracentesis, which were performed because of poor response to steroids and cylophosphamide, hemothorax developed and we therefore inserted a chest tube. The pleural effusion changed from red to milky color in several hours and we diagnosed the pleural effusion as chylothorax. Total parenteral nutrition based on medium-chain triglycerides was supplied to this patient and chylothorax was improved after 4 days.

Keyword

Chylothorax; Chest Tubes; Complications

MeSH Terms

Chest Tubes
Chylothorax
Hemorrhage
Hemothorax
Humans
Incidence
Lupus Erythematosus, Systemic
Parenteral Nutrition, Total
Pleural Effusion
Steroids
Thoracostomy
Triglycerides
Steroids
Triglycerides

Figure

• 

  Figure 1 (A) Chest X-ray study before thoracentesis. (B) Large amount of pleural effusion occurred after thoracentesis due to iatrogenic hemothorax. (C) After chest tube insertion.

• 

  Figure 2 Gross finding of pleural fluid after chest tube thoracostomy. The milky appearance of the pleural fluid with a top white, creamy layer in the container.

Reference

1. Lampson RS. Traumatic chylothorax; a review of the literature and report of a case treated by mediastinal ligation of the thoracic duct. J Thorac Surg. 1948. 17:778–791.

2. Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc. 1980. 55:700–704.

3. Hillerdal G. Light RW, Lee YC, editors. Effusions from lymphatic disruptions. Textbook of pleural diseases. 2008. 2nd ed. London: Hodder Arnold;389–396.

4. Murray JF, Jay AN, Mason RJ. Textbook of respiratory medicine. 2010. 5th ed. Philadelphia: Saunders.

5. Kumar SP, Belik J. Chylothorax--a complication of chest tube placement in a neonate. Crit Care Med. 1984. 12:411–412.

6. Limsukon A, Yick D, Kamangar N. Chylothorax: a rare complication of tube thoracostomy. J Emerg Med. 2011. 40:280–282.

7. Rosenberger A, Abrams HL. Radiology of the thoracic duct. Am J Roentgenol Radium Ther Nucl Med. 1971. 111:807–820.

8. Doerr CH, Miller DL, Ryu JH. Chylothorax. Semin Respir Crit Care Med. 2001. 22:617–626.

9. Hamm H, Pfalzer B, Fabel H. Lipoprotein analysis in a chyliform pleural effusion: implications for pathogenesis and diagnosis. Respiration. 1991. 58:294–300.

10. Agrawal V, Sahn SA. Lipid pleural effusions. Am J Med Sci. 2008. 335:16–20.

11. Maldonado F, Hawkins FJ, Daniels CE, Doerr CH, Decker PA, Ryu JH. Pleural fluid characteristics of chylothorax. Mayo Clin Proc. 2009. 84:129–133.

12. Agrawal V, Doelken P, Sahn SA. Pleural fluid analysis in chylous pleural effusion. Chest. 2008. 133:1436–1441.

13. Lin YJ, Chen DY, Lan JL, Hsieh TY. Chylothorax as the initial presentation of systemic lupus erythematosus: a case report. Clin Rheumatol. 2007. 26:1373–1374.

14. Hashim SA, Roholt HB, Babavan VK, Vanitallie TB. Treatment of chyluria and chylothorax with mediuchain triglyceride. N Engl J Med. 1964. 270:756–761.

15. Selle JG, Snyder WH 3rd, Schreiber JT. Chylothorax: indications for surgery. Ann Surg. 1973. 177:245–249.