Khoo Mohammad Shukri, Masra Farin, Ali Adli
Department of Paediatrics, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia.
Research Centre, Universiti Kebangsaan Malaysia Children's Specialist Hospital, The National University of Malaysia, Kuala Lumpur, Malaysia.
Transl Pediatr. 2023 Jul 31;12(7):1439-1449. doi: 10.21037/tp-22-636. Epub 2023 Jun 21.
Chylothorax as part of the clinical spectrum of tuberculosis (TB) is a rare entity, especially among children. However, it is crucial for clinicians to be able to identify, correlate, and diagnose chylothorax as it poses significant morbidity to patients.
We report on a paediatric case of pleural TB complicated with complex chylothorax, and systematically reviewing the literature for cases of tuberculous chylothorax among children particularly looking at the (I) demographic, (II) clinical presentations, (III) radiological findings, and (IV) investigations among this cohort of patients. The systematic review complied to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used three separate databases, namely PubMed, Ovid, and Scopus to search for articles with terms "chylothorax", "tuberculosis", and "children". We included article reporting on: (I) children aged below 18; (II) infected by , and (III) written in English only. We reviewed the publications from the inception up to August 2022. After an extensive search, 7 articles were reviewed. We included 10 patients from all the reports. Most common symptoms reported were intermittent fever (n=6) and chronic cough (n=5). Other symptoms include shortness of breath and chest discomfort due to fluid accumulation and/or effusion. Typical TB symptoms like night sweat, loss of weight, and loss of appetite were present in some of the reported patients. Chest radiography was the most used diagnostic imaging modality, in which all of the reported cases noted presence of pleural effusion, with some cases proceeded with computer tomography (CT) of thorax to aid in the diagnosis. Most of the patients had lymphadenopathies and all patients underwent pleural tapping for analysis and symptomatic relief. From the pleural fluid milky appearance and biochemistry correlation, the diagnosis of chylothorax was established in all 10 patients. Every patient was tested positive for TB infection.
Most of the cases showed similar clinical presentation, radiological findings, and laboratory investigations particularly the classic analysis findings of pleural fluid. Even though TB is not a common cause of chylothorax, clinicians should have raised suspicion of it especially after gathering full history and correlating it with the other findings.
乳糜胸作为肺结核临床谱的一部分是一种罕见疾病，尤其在儿童中。然而，对于临床医生而言，能够识别、关联并诊断乳糜胸至关重要，因为它会给患者带来严重的发病率。
我们报告一例小儿胸膜结核合并复杂性乳糜胸的病例，并系统回顾文献中儿童结核性乳糜胸的病例，特别关注（I）人口统计学特征、（II）临床表现、（III）影像学表现以及（IV）该组患者的检查情况。该系统评价遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。我们使用三个独立的数据库，即PubMed、Ovid和Scopus，以“乳糜胸”“结核病”和“儿童”为关键词搜索文章。我们纳入的文章报告需满足：（I）年龄在18岁以下的儿童；（II）受……感染，以及（III）仅用英文撰写。我们回顾了从创刊至2022年8月的出版物。经过广泛搜索，共审查了7篇文章。我们纳入了所有报告中的10例患者。报告的最常见症状为间歇性发热（n = 6）和慢性咳嗽（n = 5）。其他症状包括因液体积聚和/或胸腔积液导致的呼吸急促和胸部不适。部分报告患者出现盗汗、体重减轻和食欲不振等典型结核症状。胸部X线摄影是最常用的诊断成像方式，所有报告病例均显示有胸腔积液，部分病例进行了胸部计算机断层扫描（CT）以辅助诊断。大多数患者有淋巴结肿大，所有患者均接受胸腔穿刺以进行分析和缓解症状。根据胸腔积液的乳状外观和生化相关性，所有10例患者均确诊为乳糜胸。每位患者结核感染检测均呈阳性。
大多数病例表现出相似的临床表现、影像学表现和实验室检查结果。特别是胸腔积液的经典分析结果。尽管结核病不是乳糜胸的常见病因，但临床医生在全面了解病史并与其他检查结果相关联后，应提高对其的怀疑。
