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Chylothorax is a distinctive form of pleural effusion characterized by the accumulation of chyle within the pleural space. We conducted an analysis of published evidence concerning oncological chylothorax, encompassing complications following thoracic surgery or spontaneous occurrences directly linked to thoracic malignancies. Diagnosis can be established based on clinical features of the pleural effusion and through analysis of pleural fluid. The presence of chylomicrons, measured by lipoprotein electrophoresis, triglyceride levels, and cholesterol content are indicative factors. In cases of spontaneous chylothorax, the identification of pleural effusion on CT scans showing suspicious oncological masses, such as lymphomas, prompts pleural drainage for confirmation of chylothorax. Conversely, post-surgical chylothorax diagnoses are immediate due to the pre-existing pleural drainage. In our last 10 years of experience, we have had only 18 cases of chylothorax: 28% underwent successful redo-surgery and 72% were conservatively treated. All the patients recovered well, and none experienced life-threatening situations. Conservative approaches involve hypo/alipidic diets, total parenteral nutrition, and pharmacological interventions. In persistent and challenging cases of chylothorax where drainage output is excessive, redo-surgery is recommended.

A 67-year-old woman presented with a 1-week history of dyspnea and cough. The physical examination was notable for discolored, dystrophic fingernails and edema in the legs.

Background Kaposi sarcoma (KS) is one of the most common tumors in patients with AIDS, while the occurrence of chylous effusions in KS patients is rare and often indicates a poor prognosis. This report present a case of successfully treated AIDS-associated KS complicated by both chylothorax and chylous ascites, along with a review of the relevant literature. Case presentation A 31-year-old male patient, who was recently diagnosed with HIV infection and oral KS at our clinic center, returned two weeks post-discharge. He reported significant enlargement of the oral tumor, increased abdominal girth with accompanying abdominal distension and pain, and a dry cough over the past week. Upon readmission, CT scans indicated the presence of extensive pleural and abdominal effusions. Aspirates from both the pleural and abdominal effusions exhibited a milky chylous appearance. After eliminating other potential etiologies for the chylous effusion, we associated it with the progression of KS. The patient’s condition was ultimately successfully managed through a combination of antiretroviral therapy, systemic chemotherapy, and ntermittent thoracoabdominal paracentesis for drainage. Conclusions The development of chylous effusions in patients with AIDS-associated Kaposi sarcoma signifies disease progression. Prompt initiation of systemic chemotherapy combined with antiretroviral therapy is critical for improving outcomes.

A standardised multi-site approach to manage paediatric post-operative chylothorax does not exist and leads to unnecessary practice variation. The utilised the Pediatric Critical Care Consortium infrastructure to address this gap. Over 60 multi-disciplinary providers representing 22 centres convened virtually as a quality initiative to develop an algorithm to manage paediatric post-operative chylothorax. Agreement was objectively quantified for each recommendation in the algorithm by utilising an anonymous survey. \"Consensus\" was defined as ≥ 80% of responses as \"agree\" or \"strongly agree\" to a recommendation. In order to determine if the algorithm recommendations would be correctly interpreted in the clinical environment, we developed ex vivo simulations and surveyed patients who developed the algorithm and patients who did not. The algorithm is intended for all children (<18 years of age) within 30 days of cardiac surgery. It contains rationale for 11 central chylothorax management recommendations; diagnostic criteria and evaluation, trial of fat-modified diet, stratification by volume of daily output, timing of first-line medical therapy for \"low\" and \"high\" volume patients, and timing and duration of fat-modified diet. All recommendations achieved \"consensus\" (agreement >80%) by the workgroup (range 81-100%). Ex vivo simulations demonstrated good understanding by developers (range 94-100%) and non-developers (73%-100%). The quality improvement effort represents the first multi-site algorithm for the management of paediatric post-operative chylothorax. The algorithm includes transparent and objective measures of agreement and understanding. Agreement to the algorithm recommendations was >80%, and overall understanding was 94%.

Introduction Chylothorax is defined by the accumulation of chyle in the pleural space, characterized by triglyceride levels exceeding 110 milligrams per deciliter. The clinical presentation of chylothorax varies depending on its acuity and underlying etiology. Mediastinal lymphangiomas are extremely rare and benign lesions that can affect both infants and adults. They may occur independently or in association with other lymphatic disorders and can lead to complications such as chylothorax. Case report A 60-year-old male patient presented with shortness of breath and was diagnosed with left-sided chylothorax secondary to mediastinal lymphangioma, accompanied by intestinal lymphangiomatosis. Conservative approach was unsuccessful, and surgical therapy was needed. Materials and methods We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. The search parameters we used included the following Boolean terms: [(“lymphangioma” OR “mediastinal lymphangioma” OR “cavernous lymphangiomas” OR “cystic hygromas” OR “capillary lymphangioma” OR “lymphangioma simplex”) AND (“chylothorax” OR “chylous pleural effusion” OR “chylous effusion” OR “chylous lung”)]. Our search yielded 166 articles in total, out of which we selected 17 articles for inclusion. We included patients who presented to the hospital with chylothorax secondary to mediastinal lymphangioma and those who developed chylothorax after the removal of mediastinal lymphangioma. The primary outcome was the total number of reported cases of chylothorax secondary to mediastinal lymphangioma. The secondary outcomes included patient characteristics, fluid characteristics, clinical manifestations, and therapeutic modalities. Results The systematic review encompassed seventeen case reports. Most patients were male, spanning ages from six weeks to 82 years, with an average age of 28.35 years. Most pleural effusions were on the left side. Few cases were asymptomatic, while the most reported symptom was shortness of breath. The mean pleural triglyceride level was 708 mg/dl, with cystic hygroma being the most common subtype. The anterior mediastinum was the most frequent location. The primary treatment involved surgical removal of the lymphangioma along with thoracic duct ligation. Conclusion Mediastinal lymphangioma is an infrequent etiology of chylothorax and is scarcely documented in the literature. It may be present in isolation or may be associated with extra mediastinal lymphatic anomalies. The management of chylothorax in such cases is challenging with conservative measures often being ineffective, necessitating surgical intervention. The rarity of these conditions complicates the study of potential risk factors and genetic predispositions. Furthermore, there is no established consensus on the therapeutic modalities for patients with similar diagnoses which vary based on patient characteristics.

Earlier diagnosis of chylothorax following pediatric cardiac surgery is associated with decreased duration of chylothorax. Pleural fluid testing is used to diagnosis chylothorax which may delay detection in patients who are not enterally fed at time of chylothorax onset. Our aim was to develop and externally validate a prediction model to detect chylothorax earlier than pleural fluid testing in pediatric patients following cardiac surgery. A multivariable logistic regression model was developed to detect chylothorax using a stepwise approach. The model was developed using data from patients < 18 years following cardiac surgery from Primary Children’s Hospital, a tertiary-care academic center, between 2017 and 2020. External validation used a contemporary cohort ( n  = 171) from Lucille Packard Children’s Hospital. A total of 763 encounters (735 patients) were analyzed, of which 72 had chylothorax. The final variables selected were chest tube output (CTO) the day after sternal closure (dichotomized at 15.6 mL/kg/day, and as a continuous variable) and delayed sternal closure. The highest odds of chylothorax were associated with CTO on post-sternal closure day 1 > 15.6 mL/kg/day (odds ratio 11.3, 95% CI 6,3, 21.3). The c -statistic for the internal and external validation datasets using the dichotomized CTO variable were 0.78 (95% CI 0.73, 0.82) and 0.84 (95% CI, 0.78, 0.9) and performance improved when using CTO as a continuous variable (OR 0.84, CI: 95% CI 0.80, 0.87). Using the models described, chylothorax after pediatric cardiac surgery may be detected earlier and without reliance on enteral feeds.

This case report discusses a woman in her 30s presenting with an acute, rapidly progressive left anterior cervical swelling. While the neck swelling improved spontaneously, the patient subsequently developed large bilateral pleural effusions with respiratory failure requiring ventilatory support in the high dependency unit. Therapeutic thoracocentesis yielded chylous pleural fluid bilaterally. The respiratory failure subsequently improved and the patient was discharged home. This was an atypical presentation of chylothorax with no history of malignancy, atypical infection or apparent blunt trauma to the thoracic cage. The presence of bilateral chylothoraces suggested a multilevel thoracic duct injury. A significant tonic-clonic epileptic seizure, 6 days prior, is hypothesised as the potential underlying cause, which has not previously been reported in the literature.

Background Yellow nail syndrome is characterized by a yellow discoloration of the nails, respiratory symptoms, and lymphedema. It was first described in 1964 and has an estimated prevalence of less than 1:1.000.000. Despite its diverse manifestations affecting different organ systems and a wide range of associated diseases, yellow nail syndrome is most commonly related to impaired lymphatic drainage. The treatment depends on whether the underlying pathology can be identified and includes dietary, pharmacological, interventional, and surgical approaches. Case presentation We report the case of a 73-year-old Caucasian male patient presenting with exertional shortness of breath and orthopnea, nonpitting edema of his distal extremities, and yellow discoloration of both his finger and toe nails. The diagnostic workup, which included the drainage of a large chylous pleural effusion, computed tomography of the chest, and lymphangiography, led to the diagnosis of yellow nail syndrome, presumably caused by a mediastinal lipoma compressing the thoracic duct. Treatment-wise, a percutaneous lymphatic embolization was performed after conservative treatment did not lead to a significant improvement of symptoms. Conclusion While demonstrating the specific diagnostic findings of this case, we try to point out common pathogenetic aspects of the disorder and present the currently available treatment options.

Chylothorax refers to the accumulation of chyle in the pleural cavity and is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence of milky fluid in the pleural cavity raises suspicion for chylothorax. The most common cause is trauma, iatrogenic or non, resulting from thoracic duct injury, which transports chyle from the lymphatic system into the bloodstream. Here, we present the case of a 53-year-old female who was referred to our hospital with bilateral pleural effusions and a left supraclavicular mass. Diagnostic investigations excluded nontraumatic causes of chylothorax. The potential diagnosis was traumatic chylothorax, a diagnosis of exclusion, as it appeared after muscle strain. This condition was resolved with a fat-free diet and repose without any relapse.

Surgery is an effective treatment for chylothorax, particularly in cases of high-output chylothorax. However, precisely locating the thoracic duct for ligation and observing the surgical outcomes intraoperatively remains a challenge for surgeons. In this study, we demonstrated the feasibility of using Near-infrared (NIR) fluorescence imaging for thoracic duct ligation following indocyanine green (ICG) injection. Five patients with chylothorax who underwent surgery at our center were retrospectively included in this study. Of these, two had postoperative chylothorax following esophageal cancer surgery, one had postoperative chylothorax following lung cancer surgery, and two had spontaneous chylothorax. All patients received inguinal lymph node injections of ICG and subsequently underwent thoracic duct ligation under NIR-guided video-assisted thoracoscopic surgery (VATS) after anesthesia. All patients underwent NIR-guided ICG injection followed by VATS thoracic duct ligation. Four patients were operated on via the right side and one via the left side. The mean operative time was 62 min, the mean SBR value was 4.19, the mean postoperative drainage was 229.6 ml/day, the mean duration of postoperative chest drainage was 6.2 days, and the mean hospital stay was 17.8 days. None of the patients experienced recurrence of chylothorax postoperatively or during follow-up. In conclusion, NIR combined with ICG injection is highly effective in exploring and exposing the thoracic duct, as well as in determining the surgical outcome of thoracic duct ligation in real time.