Schroeder Jonathan Ryan, Kumar Anjan, Savage Edward, Rahaghi Franck F
Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, Atlantis, FL, USA.
BMJ Case Rep. 2012 Oct 9;2012:bcr2012006762. doi: 10.1136/bcr-2012-006762.
A 31-year-old postal worker was diagnosed with bilateral thoracic outlet syndrome and scheduled for the first of two surgeries. The first procedure involved removal of the right first cervical rib, anterior and middle scalenes. On postoperative day 4, he developed shortness of breath. Chest radiograph showed a new pleural effusion on the right. Thoracentesis revealed a yellowish-red thick effusion. Based on the initial look of the fluid it was thought to be a haemorrhagic effusion with a purulent component, further testing revealed that he had developed a chylothorax. The patient was placed on a medium-chain triglyceride diet followed by chest tube drainage. After one day, the chest tube was removed due to minimal drainage, and he was discharged home the next day. Keeping this patient without food, on total parental nutrition, or pursuing surgical intervention was not necessary, as he had an excellent outcome from a very rare surgical complication.
一名31岁的邮政工人被诊断为双侧胸廓出口综合征，并计划接受两次手术中的第一次。第一次手术包括切除右侧第一肋颈、前斜角肌和中斜角肌。术后第4天，他出现气短。胸部X光片显示右侧有新的胸腔积液。胸腔穿刺抽出淡黄色浓稠积液。根据积液的初步外观，最初认为是伴有脓性成分的血性胸腔积液，进一步检查发现他患了乳糜胸。患者接受中链甘油三酯饮食，随后进行胸腔闭式引流。一天后，由于引流量极少，拔除了胸腔引流管，第二天他出院回家。由于患者从一种非常罕见的手术并发症中获得了良好的结果，因此没有必要让该患者禁食、接受全胃肠外营养或进行手术干预。
