de Goede Barry, de Jong Louis, van Rossem Charles C, Schep Niels W L
Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
AME Case Rep. 2024 Sep 6;8:105. doi: 10.21037/acr-24-34. eCollection 2024.
Chylothorax is an uncommon condition defined by the escape of lymphatic fluid into the pleural space originating from the thoracic duct.
Our case involves a male patient in his 60s who developed traumatic chylothorax after being involved in a bicycle collision. The total body computed tomography (CT) showed multiple fractures of the ribs and spine, including a fracture of the anterior column of the Th12 vertebra. The patient was placed under observation in the intensive care unit and because of the instability of the Th12 fracture operative stabilization was performed with a percutaneous dorsal pedicle screw-rod spondylodesis. One day postoperatively, the patient suffered from acute respiratory distress; vital signs and hemoglobin levels remained stable. CT angiography was performed showing a large amount of fluid in the right pleural cavity. A chest tube was placed and a total of 3 L of fluid was evacuated. The next day a chylous production of 2 to 3 L per 24 hours was observed. Initiation of nutritional management for the patient involved a medium-chain triglyceride (MCT) diet in conjunction with total parenteral nutrition (TPN) administration. Due to the ongoing chylous leakage, despite the MCT diet and TPN, the patient underwent video-assisted thoracic surgery (VATS); the thoracic duct was identified and clipped. In addition, a VATS chemical pleurodesis with talc was performed. The chylous drainage ceased and after a total of 8 weeks the MCT diet was stopped.
This case report encompasses relevant diagnostic evaluations and the array of medical treatments applicable to a chylothorax resulting from trauma.
乳糜胸是一种罕见的病症，定义为源于胸导管的淋巴液漏入胸膜腔。
我们的病例涉及一名60多岁的男性患者，他在遭遇自行车碰撞后发生了创伤性乳糜胸。全身计算机断层扫描（CT）显示肋骨和脊柱多处骨折，包括第12胸椎前柱骨折。患者被收入重症监护病房观察，由于第12胸椎骨折不稳定，遂行经皮后路椎弓根螺钉-棒脊柱融合术进行手术固定。术后一天，患者出现急性呼吸窘迫；生命体征和血红蛋白水平保持稳定。CT血管造影显示右胸腔有大量液体。放置了胸管，共引出3升液体。第二天观察到每24小时乳糜生成量为2至3升。对患者开始营养管理，采用中链甘油三酯（MCT）饮食并结合全胃肠外营养（TPN）。尽管采用了MCT饮食和TPN，但由于乳糜持续渗漏，患者接受了电视辅助胸腔镜手术（VATS）；识别并夹闭了胸导管。此外，还进行了滑石粉电视辅助胸腔镜化学胸膜固定术。乳糜引流停止，共8周后停止了MCT饮食。
本病例报告涵盖了适用于创伤性乳糜胸的相关诊断评估和一系列医学治疗方法。
