Chylothorax as Complication Post PDA Ligation :
A Case Report
Khotimatun Hasanah, Anindita Soetadji, Agus Priyatno, Maria Mexitalia
Department of Pediatrics, Faculty of Medicine, Diponegoro University/
Dr. Kariadi Hospital, Semarang
Background
 Chylothorax is a possible complication
of intrathoracic surgery that requires
dissection near the thoracic duct.
 In children, it is usually a complication
of a cardiothoracic surgery congenital
heart disease.
 It can be life threatening because of its
respiratory, nutritional, metabolic, and
immunological consequences.
Objective
To report a case of patient with a
chylothorax following surgery of the
ductus arteriosus.
Conclusions
•Chylothorax is rare complication after
PDA ligation.
•The conservative treatment remains
the first therapeutic option before
surgery is considered.
•Dietary management have important
role in chylothorax.
Keyword: Chylothorax, complication, surgery,
PDA, medium chain fatty acids
March 5th 2017 (The chest X-ray
showed an opaque image of
pleural effusion before surgical
exploration)
Case
History
 A six-year-old girl was operated by left thoracotomy
for ligation of the ductus arteriosus at Kariadi Hospital in
March 2017.
 On day 5 post-surgery, the child was diagnosed with
left chylothorax.
Imaging
 The chest X-ray showed an opaque image of pleural
effusion.
Laboratory studies
 Pleural puncture brought back a chylous fluid.
 The level of blood triglyceride was 148 mg/dL
(normal <150) and total cholesterol was 194 mg/dL
(normal <200).
 On pleural fluid analysis showed the milky and
reddish yellow aspect of the pleural fluid, protein level
was 2.34, rivalta test positive, white blood cell : MN
6450/mmk, PMN 4500/mmk, red blood cell
24500/mmk, glucose 94 mg/dL.
 The bacteriological examination was negative.
Management
 The surgical exploration was performed.
 The treatment was based primarily on conservative
therapy such as pleural drainage and elimination of
dietary fat to reduce the flow of chyle.
 The patient went into diet rich in medium chain fatty
acids with 126% calory, 257% lipid and 365% protein.
 Clinical improvement was noted after the drainage.
March 13rd 2017 (The chest X-
ray evaluation showed an
opaque image of pleural effusion
was not obtained
after surgical exploration)