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Introduction: Chylothorax is a rare cause of pleural effusion. The most common causes are iatrogenic or medical. We report an unusual and rare cause of bilateral chylothorax., Case Report: A 73-year-old woman with no past history was admitted to the emergency department for sudden onset of dyspnoea. Chest X-ray and thoracic CT scan revealed large bilateral pleural effusions. Analysis of the fluid revealed a chylothorax. The patient was treated by chest tube drainage and a fat free (medium chain triglyceride) diet. This led to drying up of the effusions and rapid discharge. Complementary imaging examinations with chest-abdomen-pelvis CT, PET CT and pelvic MRI did not reveal any underlying cause. The final diagnosis was bilateral traumatic chylothorax caused by tearing of the thoracic duct during stretching exercises., Conclusion: Following a literature review, similar cases with the same clinical presentation were found. Combined treatment with thoracic drainage and medium chain triglyceride diet was effective in drying up the effusions. Our diagnosis was a diagnosis of exclusion. It is important to exclude a medical cause by thorough investigation., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

We report two cases of lipidic pleural effusion: an arthritis-associated pseudochylothorax and a chylous pleural effusion in a HIV seropositive patient. The incidence of lipidic pleural effusions is low, especially for pseudochylothorax. We review their clinical characteristics and management.

Spontaneous chylothorax is a rare condition, lymph node tuberculosis is an exceptional etiology of chylothorax, we report an exceptional case of a patient with mediastinal and abdominal lymph node tuberculosis presenting with spontaneous bilateral chylothorax treated successfully by symptomatic medical treatment and antibacillary., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The pleural lymphatic system has a great absorption capacity. Its most known function is fluid resorption. The pleura which cover the lungs (visceral pleura), the mediastinum, diaphragm and thoracic wall (parietal pleura) are formed by a mesothelial cell layer (mesothelium). This permeable layer is in direct contact with the vascular endothelium. The mesothelium is based over a connective tissue (interstitium) containing the blood and lymphatic vessels. The primary lymphatic vessels drain interstitium but are also in direct contact with pleural space by the stoma or openings, situated in the lower parts of parietal pleura, i.e: diaphragm, over lower ribs and mediastinum but not existing in the adjacent visceral pleura. In addition, a part of interstitial pulmonary fluid entered in the pleural cavity by passing the visceral pleura would be absorbed by these openings. The resorption process is active and directly related to the function of smooth muscles of lymphatic vessels. Besides resorption, we must emphasize that this "pumping" activity is permanent and the origin of negative pressure (the pleural void) in pleural cavity, a unique property. The other resorbed elements are molecules, bacterial and cellular debris, cells, red blood and cancer cells., (Copyright © 2013. Published by Elsevier Masson SAS.)

Gorham's disease is a rare condition of unknown etiology, which is characterized by intra-osseous vascular abnormalities leading to osteolysis and sometimes, extension to adjacent tissues. Although there is no histological evidence of malignancy, the lesions display an aggressive potential responsible of osteolysis with pathological fractures and respiratory failure. The extension of the disease varies from one location to multiple bone lesions throughout the skeleton and the clinical presentations depend on the sites of involvement. In the ISSVA (International Society for the Study of Vascular Abnormalities) classification, its affiliation to the group of vascular tumors or vascular malformations is still debated. To date, there is no standard treatment defined for this disease. The proposed treatments are inhibitors of bone resorption (bisphosphonates) and interferon alpha therapy or anti-angiogenic molecules. Radiation therapy and surgery may also have a place in the therapeutic strategy.

Chylothorax is a rare disorder occurring most often in aftermath of a thoracic surgery or during cancer of mediastinum. We report the clinical history of the world's second case of chylothorax which appeared during treatment with simvastatin., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Lymphangioleiomyomatosis is a rare pulmonary disease encountered almost exclusively in women of reproductive age. Pulmonary involvement is characterized by multiple thin-walled cysts in the lungs, recurrent pneumothorax, obstructive lung disorders, and progression to chronic respiratory failure over a mean period of 10 years. Certainty of diagnosis requires a lung biopsy, but international criteria have been proposed for a diagnosis without such a biopsy. International recommendations were recently issued for the diagnosis and treatment of lymphangioleiomyomatosis. Treatment is principally symptomatic and relies on the management of bronchial obstruction by bronchodilators; of hypoxemia by oxygen therapy; of pleural complications by pleurodesis, most often surgical; and of renal angiomyolipomas by percutaneous embolization in cases of hemorrhagic risk. Hormone treatment is not recommended. Hopes are high for mTor inhibitors (sirolimus and everolimus) and treatment trials are currently underway. Lung transplantation must be considered when chronic respiratory failure occurs in patients younger than 60 years., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Surgery is the cornerstone of treatment for resectable tumours of the oesophagus. Recent advances of surgical techniques and anaesthesiology have led to a substantial decrease in mortality and morbidity. Respiratory complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days. Respiratory complications include sputum retention, pneumonia and ARDS. They are the major cause of morbidity and mortality after oesophageal resection and numerous studies have identified the factors associated with these complications. The mechanisms are not very different from those observed after pulmonary resection. Nevertheless, there is an important lack of definition, and evaluation of the incidence is particularly difficult. Furthermore, respiratory complications are related to many factors. Careful medical history, physical examination and pulmonary function testing help to identify the risk factors and provide strategies to reduce the risk of pulmonary complications. Standardized postoperative management and a better understanding of the pathogenesis of pulmonary complications are necessary to reduce hospital mortality. This article discusses preoperative, intraoperative, and postoperative factors affecting respiratory complications and strategies to reduce the incidence of these complications after oesophagectomy.

Background: Amyloidosis is a large family of diseases defined by the presence of extra cellular protein deposits which can remain localised but are generally diffuse. Pleural involvement with effusion is rare (6% only), and difficult to diagnose because the clinical signs are non-specific., Observation: We report the case of a 77 year old man, hospitalized for anasarca, with recurring pleural effusions despite two drainages and talcage. Pleural aspiration revealed a chylothorax. ProBNP was high: 24000 ng/l. Echocardiography revealed a restrictive cardiomyopathy and suggested the diagnosis of a systemic disease. Negative peripheral biopsies led us to perform an endomyocardial biopsy, which confirmed the diagnosis of amyloidosis AL., Conclusion: We report an original case of primary amyloidosis presenting as a chylothorax and confirmed by an endomyocardial biopsy. We highlight the multi factorial character of pleural effusions associated with amyloidosis. This explains the delay in treatment and the disease's critical nature (median survival 2 months). The prognostic value of proBNP is also emphasised.

Chylothorax is an uncommon condition. It's characterized by the presence of chyle in the pleura. The most common causes are malignancy and trauma. When an underlying cause is excluded, the chylothorax is called idiopathic. We report a case of a 68 aged woman, admitted for abundant chylothorax. Thoraco-abdominal computed tomography, magnetic resonance imaging of the chest and thoracotomy showed no lesion of the lymphatic duct. Fibrothorax has developed after pleurodesis. Stable clinical and radiological condition was noticed during 3 years. We discuss the difficulty in the exclusion of a malignancy and the necessity of the follow up for these patients.

Chylothorax and chylous ascites are an accumulation of fluid containing a large proportion of triglycerides. The presence of these two effusions simultaneously is rare. A case of a patient with a known history of cirrhosis, hospitalized for an ascetic decompensation with left pleural effusion is herein presented. The woman was diagnosed as presenting both chylous ascites and chylothorax. Both fluids are transudate type fluids. After evacuation of the fluids and implementation of an adapted treatment neither effusion reappeared. The patient has been followed for the past year and has not shown any signs of relapse. Chylothorax, in cirrhotic patients is due to trans-diaphragmatic passage of fluid originating from the chylous ascites. Both extravasations have the same biological characteristics.

Chylothorax is a rare but serious complication after oesophagectomy procedure. We report the case of a 59-year-old man who underwent an oesophagectomy by Akiyama procedure. A persistent postoperative chylothorax occurred requiring drainage and conservative management. After one week, the failure of this management motivated the institution of continuous infusion of somatostatin. This led to a rapid cessation of chyle production without side effect and to the discharge of the patient from the intensive care unit.

Introduction: Complications of mechanical ventilation for severe acute asthma are common and are related essentially to barotrauma. However, the incidence has declined in recent years thanks to different techniques of ventilation., Case Report: We report a case of spontaneous chylothorax occurring during the course of ventilation in a patient with severe acute asthma where the ventilatory parameters were in accordance with current recommendations. Recovery was straightforward with resolution of the chylothorax and no recurrence either immediately or later. Exhaustive clinical, biological and morphological investigations failed to find any cause other than the mechanical ventilation., Conclusion: This case of chylothorax may be considered as a rare barotraumatic complication of severe acute asthma.

Bourneville's disease, first described in 1862, is a phacomatosis that is either autosomal dominant or sporadic. Its typical clinical signs include mental retardation, epilepsy and cutaneous adenomas. The pulmonary form is rare, less than 1%, and is secondary to occlusion of the bronchus, vascular and lymphatics by immature smooth muscle cells. Chylothorax may appear in more than 50% of all cases. No guidelines currently exist for treatment of recurrent chylothorax. However, several possibilities are described in the literature.

PHYSIOLOGY: Chylothorax corresponds to the intrathoracic presence of chyle. Chyle is a lymph of intestinal origin containing the product of digested fat. This lymph joins the blood circulation through the thoracic duct. The thoracic duct receives a part of the lymphatic drainage from the viscera below the diaphragm, from the diaphragm and from the sterno-costal wall., Physiopathology: Intrapleural chyle issue is explained by an acquired or spontaneous lesion of the thoracic duct or of one of its collaterals in the thorax. The iatrogenic or spontaneous lesions of the collaterals suggest that the latter are incontinent and have lost their valve capacity, and hence provoke a reflux of chyle from the thoracic duct. The anatomy of the chylothorax (occasionally pathological) can be specified by a pedal lymphography. FROM A THERAPEUTIC POINT OF VIEW: Treatment, essentially medical, can be completed by surgery. The medical treatment is based on re-nutrition and a diet excluding fat, supplemented by medium chain triglycerides. Surgery consists in pleural symphysis and/or suture of the damaged collaterals, or ligature of the thoracic duct. The indications depend on the severity of the chyle leakage and the type of original lesion. The indications therefore depend on the etiology and clinical evolution of each case. These different treatments, isolated or combined, lead to the regression of the effusion in nearly all cases.

Chylothorax is a rare but life-threatening complication of esophagectomy for cancer. Elective ligation of the thoracic duct above the diaphragm does not suppress completely the risk of chylothorax due to possible trauma of the thoracic duct wall at the level of ligation, or incomplete ligation in case of anatomic variation. This study describes a technique of preventive ligation "en block" with surrounding tissues in order to minimize the risk of chylothorax following oesophagectomy, whatever performed transthoracically or through transhiatal approach.

We report an unusual case of pulmonary lymphangioleiomyomatosis in a menopaused woman who had been taking estrogen hormone replacement therapy for several years. The characteristic feature of this uncommon disease is a proliferation of non-tumoral abnormal smooth muscle cells within the alveolar walls, and around the bronchi, lymph nodes and blood vessels. About twenty cases of pulmonary lymphangioleiomyomatosis have been described in menopaused women, who generally were taking estrogen hormone replacement therapy. This subpopulation does not appear to present any particular clinical, functional or radiographic features.

We present a new case of bilateral spontaneous idiopathic pneumothorax, occurring in a 52-year-old woman. A literature review of similar cases shows a quite reproducible picture, consisting in the occurrence of supraclavicular swelling and left or bilateral chylothorax after a mild effort in a woman in her fifties.

We report a case of bilateral chylothorax revealing diffuse tuberculosis. The clinical presentation was complicated by the apparition of a massive acute pulmonary embolism and an acute respiratory distress syndrome. Mycobacterium tuberculosis was isolated from the cultures of the bronchi aspiration of the bronchoscopic examination. With antituberculous chemotherapy, the course of the chylothorax was satisfactory.

Pleural involvement is frequently seen among patients hospitalized in Intensive Care Units (ICU). In most cases, patients are hospitalized with or will develop scarce transsudative effusion secondary to cardiac failure or atelectasis. Other pleural issues in ICU concern pneumothorax in ventilated patients (barotrauma), empyema following nosocomial pneumonia or investigation procedures. More rarely hemo(pneumo)thorax or chylothorax will be diagnosed. As a rule, acute pleural pathologies rarely justify hospitalization in the ICU, depending on the etiologic mechanism or concomittant clinical signs of intolerance (respiratory insufficiency, collapsus, coma...). After tube thoracostomy, most patients will be managed in the respiratory ward to monitor the drainage, to begin etiologic diagnosis and to discuss a possible surgical intervention, usually a few weeks or months after the ICU.

Aim of the Study: The aim of this prospective study was to report early results of videothoracoscopic truncal vagotomy in non-complicated chronic duodenal ulcers., Patients and Methods: From 1995 to 1998, 250 patients suffering from chronic duodenal ulcer without pyloric stenosis were operated on in the main hospital of Dakar. They underwent videothoracoscopic truncal vagotomy without gastric drainage. The quality of gastric emptying and the incidence of secondary side-effects were assessed in the postoperative course and after one and three months., Results: There were two intraoperative deaths, one due to aortic wound and the other one due to a poor surveillance after premature extubation. Postoperative complications included bronchopulmonary infection (n = 9), one septic pleural effusion and one chylothorax. A postoperative gastroplegia occurred in 12 patients, which was always spontaneously regressive without endoscopic pyloric dilatation. After one month, 204 patients (82%) were classified Visik 1, and 44 (18%) classified Visik 2. An endoscopic control examination showed a healed peptic ulcer and open pylorus in all patients, and a gastric stasis present in 40 cases (16%). After three months and a new evaluation, 234 were classified Visik 1 (94%) and 14 Visik 2 (6%). Dumping syndrome was not observed in this series and the incidence of diarrhea, which was 40% after one month, decreased to 3% after three months., Conclusion: The functional results of truncular vagotomy without gastric drainage were good or very good and improved with time. The quality of digestive comfort and the low frequency of side-effects are good arguments in favor of this procedure as an elective treatment of duodenal ulcers in developing countries.

The authors report a case of massive osteolysis of the spine in an eighteen years old boy presenting a T9 collapse without neurological symptoms associated to a right chylothorax which disappeared after 5 days of drainage. MRI showed an increased signal on T1 and T2 weighted sequences. An orthopaedic treatment with a cast was decided as a first attempt. Because on increasing pain and kyphosis, surgery was considered, with posterior segmental fixation with Hartshill rectangle from T4 to L5. The result was satisfactory after 6 months of follow-UP. The vanished bone disease is a rare affection of unknown aetiology. 132 cases were published, 20 with spinal localization. The prognosis is uncertain with a mortality of 16 per cent. The treatment of bony lesions is difficult. Spinal localizations are best treated by segmental fixation extended on normal vertebrae.

The authors describe a case of spontaneous chylothorax occurring in a 50-year-old woman after stretching exercises of the upper limbs. A positive diagnosis was made based on pleural aspirate and a biochemical study of the pleural liquid (triglycerides > 3 gm/l). The chylothorax is said to be spontaneous when detailed investigations are negative. The outcome was satisfactory with complete regression of the symptoms after pleural aspirate and a low diet in long chain triglycerides but the authors recall that treatment may be surgical in cases of multiple recurrence.

The association of sarcoidosis and chylothorax is rare. A patient aged 64 presented with mediastinal sarcoidosis. Two years after the diagnosis he developed a right chylothorax. The computed tomographic examination showed a retraction of the right hemithorax associated with large mediastinal nodes, without signs of interstitial lung disease. Pulmonary function tests revealed a restrictive ventilatory defect with a Forced Vital Capacity (FVC) of 53% and a Forced Expired Volume in one second (FEV1) of 54% from the predicted values; the FEV1/FVC ratio was 78%. Steroid therapy was started at 1 mg per kilogram per day for three months then progressively decreased to 15 mg per day. Inspite of the steroid therapy there was as well biological evidence of continued disease activity (bronchoalveolar lavage lymphocytosis and increased serum angiotensin converting enzyme), as persistence of pleural effusion and mediastinal adenopathy; the contraction of the right hemithorax increased. Restrictive ventilatory defect worsened with a FVC of 44% and an FEV1 of 47% of the predicted values. The presence of a significant contraction of the hemithorax and of a severe restrictive ventilatory defect suggested the existence both of pleural fibrosis and of a compression of the main lymphatic pathways responsible for the chylothorax.

We report a case of traumatic chylothorax which occurred after a right subclavian vein catheterisation. Chyle output exceeded 4 L.day-1 despite a continuous drainage of the pleural space, cessation of oral intake and mechanical ventilation. It was cured by addition of PEP to ventilation. The various causes and therapeutic approaches are reviewed.

Chylothorax following blunt chest trauma is a rare event. The presence of a cloudy or milky persistent pleural effusion should suggest the possibility of its chylous origin. The diagnosis is made by analysis of the fluid obtained either from thoracentesis or tube thoracostomy. A lymphangiogram can show the site of the lesion, but computed tomography is a more recent and probably as helpful diagnostic test. An efficient control of the chylous effusion may be facilitated by using a fat-poor enteral nutrition and parenteral nutrition, which prevents malnutrition. Surgical ligation of the thoracic duct is relatively simple and efficient. It is indicated when the daily chylous flow is over 500 mL after 2 or 3 weeks of medical treatment or in case of weight loss.

Chylothorax is a rare complication of thoracic surgery. The chyle leak can induce serious metabolic and immunological disorders. The ideal treatment of chylothorax has not been clearly established, and opinions are still divided between medical treatment and early or late surgical reoperation after prolonged medical treatment. Out of a total of 1.750 thoracic operations performed at the Centre Chirurgical du Val d'Or over the last 10 years, six cases of chylothorax were reoperated early, an average of five days after the initial operation. The chyle leak was easy to localize in every case. The second operation was performed via the same initial incision. All six patients has an uneventful postoperative course and only one case had a persistent chyle leak which gradually resolved. The mean total hospital stay was 18 days. No systemic infections or deaths were recorded. Early reoperation avoids the complications of prolonged medical treatment, is technically easy and decreases the length of hospital stay.

The authors report a case of pseudochylothorax revealed by pleural tuberculosis. Classically, pseudochylothorax is a late complication of chronical and calcified pleurisy especially sequellae of tuberculosis treated by induced pneumothorax. Treatment consist on thoracentesis or aspiration with frequent remove. Surgical decortication can be useful. Specific chemotherapy is only necessary in the patients in whom tuberculosis is present or never treated with antibiotics.

BACKGROUND. Post-operative chylous effusion is rare in infants. It may result from venous thrombosis, thoracic duct injury or lymphatic vessel obstruction. This paper describes 2 cases of diaphragm hernia with post-operative chylous effusion. CASE REPORTS Case 1: A newborn developed chylous ascites two weeks after repair of a left posterolateral diaphragm hernia. Abdominal paracentesis showed milky fluid containing numerous lymphocytes (98%). Ascites was rapidly reduced by feeding with medium-chain triglyceride-rich (MCT) formula. Case 2: A chylothorax was seen 7 days after surgery to repair a left posterolateral diaphragm hernia. Thoracocentesis showed serous fluid containing numerous lymphocytes (93%). The chylothorax was resolved after two thoracocenteses, parenteral nutrition and feeding with MCT formula. CONCLUSION. These cases are the third report of chylothorax and the second report of chylous ascites after surgical repair of a diaphragm hernia. The exact cause of the chylous effusion is not clear.

Transaxillary upper thoracic sympathectomy is a safe surgical procedure for the treatment of palmar hyperhidrosis. Although thoracic complications such as hemothorax and pneumothorax occasionally occur following this procedure chylothorax is an extremely rare complication. From 1978 to 1991, 215 consecutive patients underwent upper thoracic sympathectomy for the treatment of palmar hyperhidrosis in our institution. We report the surgical management of one patient who developed an intractable chylous fistula which did not respond to non-surgical treatment. Attempts at non-surgical management of the disease, with aspiration therapy, tube thoracostomy and the administration of medium chain triglyceride diet, should be tried first. If, however, this is not successful within two weeks, one should not wait for further metabolic and nutritional impairment before instituting surgical treatment. We believe that proximal thoracic duct ligation is a relatively simple and effective means of controlling chylothorax.

Isolated chylopericardium is a rare entity with an obscure aetiology. "Cardiomegaly" was discovered incidentally in a 40 year old woman and was found to correspond to chylopericardium. The patient was referred to us after a failed attempt of left pericardio-pleural fenestration. Lymphography revealed injection of the left anterior mediastinal lymph node chain from the arch of the thoracic duct. At operation, the chylous leaks were sutured from this chain. Anatomical study of the lymphatic drainage of the heart revealed interconnections between the left anterior mediastinal, left recurrent, left suprabronchial lymph node chains and the thoracic duct. A review of the literature confirmed that chylous leak generally occurs from this lymphatic system when the cases reported have been investigated by lymphangiography or explored surgically.

A mediastinal chylous effusion occurred in a young woman after a mediastinoscopy. This effusion healed rapidly with medical treatment. An understanding of the anatomy of these intra-thoracic/lymphatic channels explains that intra-thoracic chylous effusions may occur in case of incontinence of the lymphatic vessels which connect the tracheo-bronchial nodes to the thoracic duct in the mediastinum. This is very important following the surgical excision of a node because incontinent lymphatic vessels are directly sectioned. When the lymph nodes are biopsied in an enclosed cavity such as the mediastinum, the quantity of lymphoid tissue acts as an obstacle to reflux of the lymph which is thus less significant and more easily controlled.

The authors report a new case of bilateral chylothorax predominant on the left side, which occurred after movements of body trunk hyperextension in a 52-year old woman without any notable history. The clinical signs revealing the lesion were left thoracic pain and dyspnoea. The effusion had been preceded by a painless and transient left cervical tumefaction. The outcome was favourable after two left pleural draining punctures and rest.

Bilateral chylothorax following radical neck dissection is an uncommon complication of head and neck surgery. Only 9 more cases have been reported in the English literature until now. Early recognition is not difficult if it is bear in mind when evaluating dyspnoeic patients with bilateral pleural effusions after neck dissection. In this paper the authors report their experiences with a case and comment on the treatment employed. The authors believe that due to its potential severity, it must be considered when ever head and neck surgery is performed.

Chylous ascites complicating surgery on the abdominal aorta is infrequent: we report one case associated with right chylothorax, secondary to the surgical cure of an inflammatory aortic aneurysm. Surgery for aneurysms causes 81% of all chylous ascites caused by injuries to the intestinal lymphatics or to their recipients, the left latero-aortic lymph nodes or the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the major etiological factors. Stasis and fibrosis, then the rupture of the lymphatics into the aneurysmal wall were described during inflammatory aneurysm: this lymphatic etiology might explain the inflammatory character of these aneurysms and entail a risk of lymphoperitoneal fistula when laying the aneurysmal wall flat. An early diagnosis must be established with paracentesis before any compressive, metabolic, immunological or septic complications occur. Continuous parenteral feeding and selective paracenteses dry out 80% of the postoperative chylous ascites. If the ascites persists after 4 to 6 week's conservative treatment, a peritoneojugular derivation or a direct lymphostasis may be contemplated, according to the patient's condition.

We report a case of abdomino-thoracic oesophageal duplication revealed by prenatal ultrasonography as a liquid mass in the posterior mediastinum, responsible for a major chylothorax. Tow our knowledge, this is the first thoroughly documented case occurring in the prenatal period. The various possible ultrasonographic diagnoses and the possibility of therapeutic drainage of pleural effusions are discussed in the light of anatomy, embryogenesis and ultrasonographic images of the lesion.