29/5/2014 An idiopathic congenital chylothorax: surgery o... [BMJ Case Rep.

2014] - PubMed - NCBI

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BMJ Case Rep. 2014 Apr 30;2014. pii: bcr2014204147. doi: 10.1136/bcr-2014-204147.

An idiopathic congenital chylothorax: surgery or conservative

management?
Perisson C1, Nathan N, Larroquet M, Corvol H.

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Abstract
A 3-month-old infant was admitted to the respiratory unit for dyspnoea and vomiting after her second
DTaP-Polio vaccine shot. The chest X-rays showed a white right lung with a left mediastinal shift. A
pleural aspiration assessed the diagnosis of chylothorax. A conservative treatment was initiated
with a fat-free diet and pleural aspirations. As this treatment was ineffective, a total parenteral
nutrition was started at day 11, plus increasing doses of Octreotide. As the chylothorax persisted at
day 50, a pleuroperitoneal shunting was performed but a pleurodesis was finally necessary. The child
was discharged from the hospital 6 weeks after the surgery. Ten months later, her physical and
biological conditions were normal and her chest X-rays dramatically improved. This case highlights
the difficult management of infant chylothorax. Although conservative treatment has to be tried first,
surgical procedures as pleuroperitoneal shunting and rarely pleurodesis have to be discussed.

PMID: 24788632 [PubMed - in process]

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Stefan Pokall 2014 May 07 10:24 a.m. 1 of 1 people found this helpful
I wonder about the title since the answer is given by the clinical course and the chyle output.
What this article adds is a late presentation with 3 months of age without a prenatal or perinatal
history. The conclusion that pleuroperitoneal shunt is the first procedure to perform in children is
not supported in literature, rather a TDL as demonstrated in cardiothoracic studies by Cleveland
K 2009 and Nath DS 2009 and even Azizkhan recommends it secondary to pleurodesis
(textbook ziegler/azizkhan/weber Fig.41-5).
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29/5/2014 An idiopathic congenital chylothorax: surgery o... [BMJ Case Rep. 2014] - PubMed - NCBI

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