Methlouthi Jihène, Mahdhaoui Nabiha, Bellalah Manel, Selsabil Nouir, Hedia Ayache, Sfar Raja, Essabah Habib, Abdellatif Nouri, Sonia Nouri, Hassen Seboui
Faculté de Médecine de Sousse, Unité de Réanimation Néonatale Code (UR/99/UR/08-65), Service de Néonatologie CHU Farhat Hached Sousse, Tunisie.
Service de Médecine Nucléaire CHU Sahloul Sousse, Tunisie.
Pan Afr Med J. 2016 Aug 22;24:321. doi: 10.11604/pamj.2016.24.321.8014. eCollection 2016.
Chylothorax is defined as accumulation of lymphatic fluid in the pleural space. Chylothorax in the neonatal period can be classified into three distinct categories: congenital chylothorax (CC), syndromic or malformative chylothorax (MC) and postoperative chylothorax (CO). Although rare, chylothorax is the most common cause of pleural effusions in the neonatal period. Making a positive diagnosis is easy by examination of the pleural fluid, but its mechanism and especially the integrity of thoracic duct and its collateral branches is sometimes difficult to determine. Lymphoscintigraphy is the test of choice in etipathogenic diagnosis. This diagnostic tool can be coupled, if possible, to SPECT-CT (single photon emission tomography / computed tomography) providing more specific anatomical informations. Tratment of chylothorax is based on the drainage of the pleural fluid, the suppression of dietary fats and on parenteral nutrition. Surgery is recommended in the case of medical treatment failure. We report the case of a newborn with unilateral chylothorax who did not respond to medical treatment. Lymphoscintigraphy allowed to diagnose etiopathogenic mechanism underlying chylothorax and therefore to direct surgical treatment.
乳糜胸被定义为胸膜腔内淋巴液的积聚。新生儿期乳糜胸可分为三种不同类型：先天性乳糜胸（CC）、综合征性或畸形性乳糜胸（MC）和术后乳糜胸（CO）。尽管罕见，但乳糜胸是新生儿期胸腔积液最常见的原因。通过检查胸腔积液做出阳性诊断很容易，但其机制，尤其是胸导管及其分支的完整性有时难以确定。淋巴闪烁显像术是病因诊断的首选检查。如果可能，这种诊断工具可以与单光子发射断层扫描/计算机断层扫描（SPECT-CT）相结合，提供更具体的解剖信息。乳糜胸的治疗基于胸腔积液引流、饮食脂肪抑制和肠外营养。在药物治疗失败的情况下建议进行手术。我们报告了一例单侧乳糜胸新生儿，其对药物治疗无反应。淋巴闪烁显像术能够诊断乳糜胸的潜在病因机制，从而指导手术治疗。
