Chylothorax related to acute SARS-CoV-2 infection in a patient with Noonan syndrome with prior uncomplicated cardiac surgeries.

SARS-CoV-2 is a novel coronavirus that has rarely been associated with chylothorax. Patients with Noonan syndrome are at risk for developing chylothorax, especially after cardiothoracic interventions. We present the case of SARS-CoV-2 infection triggering the underlying tendency of a patient with Noonan syndrome to develop chylothorax who did not develop it even after prior cardiothoracic interventions. Patient presented in respiratory distress without hypoxia and was found, on imaging, to have a large right-sided pleural effusion, which was eventually classified as chylothorax. The patient was then started on a low-fat diet. Chest tube drainage substantially reduced the effusion in size, and it remained stable. Our report highlights that SARS-CoV-2 infection can cause the development of a chylothorax or a chylous effusion in patients with Noonan syndrome or among populations with a similar predisposition. A high index of suspicion in vulnerable patients or those not responding to traditional therapy should exist with providers, thus leading to the testing of the fluid to confirm the diagnosis.

[Chylothorax]. / Chylothorax.

Chylothorax is a serious and potentially life-threatening condition of diverse etiology. This article provides a detailed overview of anatomy, physiology, etiology, diagnosis, and therapeutic options in the context of chylothorax.

Neonatal perspective on central lymphatic disorders.

Lymphatic disorders presenting in the first year of life are difficult to identify and manage given the broad range of underlying etiologies. Neonatal lymphatic disease arising from congenital or acquired conditions results in the abnormal accumulation of lymph fluid in the pleura (chylothorax), peritoneum (chylous ascites) and skin (edema/anasarca). There is also increasing recognition of lymphatic losses through the intestine resulting in protein-losing enteropathy (PLE). While the incidence of lymphatic disorders in neonates is unclear, advances in genetic testing and lymphatic imaging are improving our understanding of the underlying pathophysiology. Despite these advancements, medical management of neonatal lymphatic disorders remains challenging and variable among clinicians.

Recurrent bilateral idiopathic chylothorax: a therapeutic challenge.

Chylothorax is a rare condition caused by pleural effusion resulting from thoracic duct injury. Recurrent chylothorax is often resistant to conservative treatment and presents a clinical conundrum in its management. Here, we report a compelling case of recurrent chylothorax that persisted despite the administration of total parenteral nutrition, octreotide and thoracic duct embolisation. The patient eventually required thoracic duct ligation and talc pleurodesis, which resulted in the resolution of the effusion. Our case is an illustrative example of the effective multidisciplinary management of recurrent bilateral idiopathic chylothorax.

Reporte de un caso de quilotórax tuberculoso / A case report of tuberculous chylothorax

El quilotórax tuberculoso es una patología infecciosa infrecuente, que se produce como consecuencia del bloqueo del conducto torácico. Su tratamiento está dirigido a combatir la infección tuberculosa. Se presenta el caso de un varón de 55 años de edad, chofer, natural de Trujillo-Perú, que acudió a emergencia por disnea progresiva y tos seca de cinco días de evolución. El examen físico reveló frémito vocal, matidez y murmullo vesicular disminuido en 2/3 inferiores del hemitórax izquierdo. La radiografía y ecografía torácica evidenciaron derrame pleural significativo, y la toracocentesis reveló quilotórax. Posteriormente, se colocó un tubo de drenaje torácico, con disminución progresiva del volumen del líquido pleural y cambios citoquímicos. Se realizó videobroncoscopía diagnóstica con aspirado broncoalveolar, revelando bacilos ácido-alcohol resistentes. El paciente recibió tratamiento antituberculoso, con evolución favorable. El quilotórax tuberculoso constituye una causa importante de quilotórax a considerar en zonas endémicas de tuberculosis. El tratamiento adecuado de la infección, conlleva a resolución de la enfermedad.

Tuberculous chylothorax is a rare infectious disease that occurs when the thoracic duct is obstructed. Treatment is directed to the tuberculosis infection. A 55-year-old male, driver, born in Trujillo (Peru) is admitted to the emergency department with increasing dyspnea and a 5-day dry cough. The physical examination revealed vocal fremitus, dullness to percussion, and a vesicular murmur that was decreased on the lower 2/3 of the left hemithorax. The X-ray and the thoracic ultrasound revealed significant left pleural effusion. The thoracocentesis drained fluid identified as chylothorax. Subsequently, a thoracic tube was placed, with a decrease in pleural fluid volume and later normalization of the cytochemical changes. Diagnostic video bronchoscopy was performed with a bronchoalveolar aspirate, revealing acid-fast bacilli. The patient received antituberculosis treatment with a favorable outcome. Tuberculous chylothorax is an important cause of chylothorax to be considered in endemic areas of tuberculosis. Proper treatment of the infection leads to resolution of the disease.

Generalidades del quilotórax en el paciente adulto / Generalities of the chylothorax in the adult patient

Resumen El quilotórax se produce ante la ruptura, desgarro u obstrucción del conducto torácico o sus afluentes principales, lo que resulta en la liberación de quilo al espacio pleural. Ocurre más frecuentemente asociado a trauma o a lesiones malignas; pero han sido descritas otras causas. El diagnóstico se obtiene mediante toracocentesis y la determinación de las concentraciones de triglicéridos y colesterol en el líquido pleural. Las complicaciones incluyen la desnutrición, inmunosupresión y compromiso respiratorio. El tratamiento puede ser conservador o agresivo en función de la situación clínica.

Abstract Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct or its main tributaries, resulting in the release of chyle into the pleural space. It most commonly occurs from trauma or malignancy, but other causes have been described. Diagnosis involves thoracocentesis and cholesterol and triglyceride measurement in the pleural fluid. Complications include malnutrition, immunosuppression and respiratory distress. Treatment may be either conservative or aggressive depending on the clinical scenario.

Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional / Prevalence of intimate partner physical violence in men and women from Florianópolis, Santa Catarina State, Brazil: a population-based study / La prevalencia de la violencia física en parejas íntimas entre hombres y mujeres de Florianópolis, Santa Catarina, Brasil: estudio basado en la población

Investigou-se a associação entre sexo e violência física entre parceiros íntimos. Encontrou-se prevalência de sofrer qualquer violência física (17%), violência física moderada (16,6%) e violência física grave (7,3%). Não houve diferença significativa para violência física moderada em homens e mulheres, porém, quanto mais grave o ato maior a ocorrência deste nas mulheres. Por meio de regressão logística testou-se a associação da violência com o sexo, ajustando-se às variáveis exploratórias. Mulheres de maior idade, viúvas/separadas, pobres, menos escolarizadas e pretas registram maior probabilidade de sofrer violência. Nos homens, a prevalência de violência física grave apresentou alteração significativa apenas para estado civil. Uso abusivo de álcool por mulheres representou maior chance de sofrer violência física.

This study investigated the association between gender and intimate partner physical violence. A random cluster sample was chosen as the baseline cohort population in a cross-sectional design. Lifetime prevalence rates were as follows: any physical violence (17%), moderate physical violence (16.6%), and severe physical violence (7.3%). There were no significant differences between genders in moderate physical violence, but women were more likely to suffer severe abuse. Logistic regression was used to identify associations between violence and gender, adjusting for exploratory variables. Women that were older, widowed/separated, had less schooling or lower income, and African-descendants were all more likely to have suffered intimate partner violence. Prevalence of severe physical violence experienced by men only changed significantly according to marital status. Alcohol abuse by women increased the odds of suffering physical violence.

Se investigó la asociación entre el sexo y la violencia física entre parejas íntimas. La prevalencia de sufrir violencia física (17%), la violencia física moderada (16,6%) y la violencia física grave (7,3%). No hubo diferencia significativa en la violencia física moderada en hombres y mujeres, sin embargo, más grave es la mayor ocurrencia de este hecho en las mujeres. Por regresión logística se evaluó la relación entre la violencia y el sexo, y el ajuste de las variables exploratorias. Las mujeres mayores de edad, viudas/separadas, más pobres, menos educadas y negras son más propensas a sufrir violencia. En los hombres, la prevalencia de la violencia física grave cambió significativamente sólo con el estado civil. El abuso de alcohol por mujeres representan un mayor riesgo de sufrir violencia.

Quilotórax bilateral y linfoma simultáneo en dos varones: presentación de dos casos / Bilateral chylothorax and simultaneous lymphoma in two male patients: report of two cases

El quilotórax es una enfermedad grave, más aún si es bilateral y de causa maligna, pero tiene tratamiento y el enfermo puede estabilizarse.Objetivo: presentar dos pacientes de interés médico y demostrar que puede esperarse buena respuesta al tratamiento.Casos Clínicos: se presentaron dos enfermos portadores de quilotórax bilateral y linfoma, ambos varones, atendidos en el hospital de forma simultánea; se realizaron los exámenes complementarios diagnósticos. El diagnóstico en ambos resultó linfoma no Hodgkin y Hodgkin respectivamente, fueron tratados con dieta, se restringieron las grasas; tratamiento oncoespecÍfico y toracocentésis repetidas en ambos hemitórax. El primero, mejorado del derrame bilateral y síntomas inicialmente, fallece a los 11 meses por no control de su enfermedad base. El segundo, estable de ambas afecciones a los 18 meses, en ambos casos el quilotórax se compensó y no fue necesario repetir drenaje. Se hacen análisis comparativo con otros reportes sobre todo cuando el linfoma es la causa etiológica, la conducta adoptada concuerda con otros estudios actuales.Conclusiones: los enfermos mejoraron del quilotórax bilateral, uno no estabilizó su enfermedad de base y murió, mientras el otro está asintomático. Puede obtenerse buena respuesta terapéutica...

Chylothorax is a serious disease, even more if it is bilateral and of a malignant cause; but it has treatment and the patient’s condition may be stable.Objective: to present two patients of medical interest and prove that a good response from the treatment may be expected.Clinical cases: two male patients with bilateral chylothorax and lymphoma were simultaneously attended at the hospital. Complementary diagnostic tests were made. The diagnosis of both patients turned out to be non-Hodgkin’s and Hodgkin’s lymphomas respectively. They were put on a diet in which fat was cut; the oncospecific treatment and repeated thoracocentesis were applied in both hemithoraxes. The first patient, after getting better from the bilateral effusion and initial symptoms, passed away 11 months later for not controlling the base disease. The second patient presented a stable condition of both complaints 18 months later. In both cases chylotorax was eased and it was not necessary to repeat the drainage. Analyses compared to other reports are made mainly when the lymphoma is the etiological cause; the adopted conduct coincides with other current studies.Conclusions: the patients got better from bilateral chylothorax; one of them did not get a stable condition of his base disease and died and the second one is asymptomatic. A good therapeutic response may be obtained...

Quilotórax bilateral posterior a trauma de tórax cerrado / Bilateral chylothorax after a blunt chest trauma

El término quilotórax se refiere a la presencia de quilo en el espacio pleural, es usualmente secundario a la ruptura del conducto torácico, a una se sus ramas o debido a alguna alteración del flujo del quilo. Algunas de sus causas: son trauma, neoplasias, misceláneas e idiopáticas. Está asociado a una alta morbilidad y mortalidad. Su manejo puede ser conservador o quirúrgico...

Videotoracoscopia como uma opção no tratamento cirúrgico do quilotórax após cirurgia cardíaca pediátrica / Video-assisted thoracoscopy as an option in the surgical treatment of chylothorax after cardiac surgery in children

OBJETIVO: Avaliar o uso de videotoracoscopia no tratamento cirúrgico do quilotórax após cirurgia para correção de cardiopatias congênitas em crianças. MÉTODOS: Revisamos os prontuários médicos de 3.092 crianças operadas para a correção de cardiopatias congênitas no Instituto do Coração/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) entre fevereiro de 2002 e fevereiro de 2007. RESULTADOS: Das 3.092 crianças, 64 (2,2 por cento) apresentaram quilotórax como complicação pós-operatória. Em 50 (78,1 por cento) dessas, o tratamento clínico foi bem-sucedido, enquanto esse falhou em 14 (21,9 por cento), as quais foram submetidas à ligação do ducto torácico por videotoracoscopia. A ligação do ducto torácico obteve sucesso em 12 pacientes (86 por cento) e falhou em 2 casos, os quais foram resolvidos com medidas clínicas adicionais, como dieta pobre em gorduras e nutrição parenteral. Não houve morbidade ou mortalidade relacionada à operação. Dos 14 pacientes, 5 (35 por cento) faleceram em decorrência de complicações cardíacas ou infecciosas. CONCLUSÕES: A ligadura videoassistida do ducto torácico pode ser realizada com segurança em pacientes gravemente enfermos e com doença cardíaca grave, com resultados favoráveis.

OBJECTIVE: To evaluate the use of video-assisted thoracoscopy in the surgical treatment of chylothorax developed after the surgical correction of congenital heart disease in children. METHODS: We reviewed the medical charts of 3,092 children who underwent surgery for congenital heart disease between February of 2002 and February of 2007 at the Heart Institute of the University of São Paulo School of Medicine Hospital das Clínicas, in São Paulo, Brazil. RESULTS: Of the 3,092 children, 64 (2.2 percent) presented with chylothorax as a postoperative complication. In 50 (78.1 percent) of those patients, the clinical management was successful, whereas it failed in 14 (21.9 percent), all of whom were then submitted to thoracic duct ligation by video-assisted thoracoscopy. The thoracic duct ligation was successful in 12 patients (86 percent) but failed in 2. In the postoperative period, additional clinical measures, such as a low-fat diet and parenteral nutrition, were required in order to resolve those 2 cases. There was no surgical morbidity or mortality. Of the 14 patients who underwent thoracic duct ligation, 5 (35 percent) died due to cardiac or infectious complications. CONCLUSIONS: Video-assisted thoracic duct ligation can be safely performed in patients with severe heart disease, and the outcomes are favorable.

Quilotórax bilateral asociado a linfoma no Hodgkin, folicular: génesis del quilotórax / Bilateral chylothorax associated to non-hodgkin's follicular lymphoma: the origin of chylothorax

Varón de 50 años, con 7 meses de enfermedad caracterizada por mialgias, astenia, y malestar general. cinco meses antes de ingresar al Hospital Dos de Mayo (HNDM), desarrolla derrame pleural derecho que requiere drenaje pleural (1500-2500 cc/día). Internado en el HNDM se descubre un derrame pleural bilateral con incremento de triglicéridos. Una tomografía espiral multicorte (TEM), de tórax con contraste demostró adenopatías mediastinales, derrame pleural bilateral, liquido al interior de la pleura mediastinal derecha posterior adyacente a D10-D11-D12, e imagen osteolítica en cuerpo vertebral de D11. Una biopsia de ganglio axilar izquierdo, reveló un Linfoma no Hodgkin (LNH), folicular de células grandes y pequeñas. Estando sometido a una dieta alta en triglicéridos de cadena media y aceite de oliva como suplemento el paciente recibió quimioterapia (Dexametasona, Ciclofosfamida, Doxorrubicina, Vincristina), siendo dado de alta después del primer ciclo, con programación de quimioterapias cada 3 semanas y toracocentesis evacuatorias periódicas condicionales. Después de 5 meses de tratamiento, el quilotórax bilateral desapareció.

This is the story of a 50 year-old male subject with a 7-month illness characterized by myalgia, fatigue, and malaise. 5 months before being admitted to Dos de Mayo National Hospital (HNDM), he developed right pleural effusion requiring pleural drainage (1500-2500 mL/day).While in HNDM, the patient developed bilateral pleural effusion with increased triglycerides. A multiple-slice contrast spiral CT (TEM) of the chest showed mediastinal lymph node enlargement, bilateral pleural effusion, and the presence of fluid within the right posterior mediastinal pleura adjacent to D10-D11-D12, and an osteolytic image in D11 vertebral body. A left axillary lymph node biopsy revealed non-Hodgkin lymphoma (NHL), follicular type with large and small cells. The patient received a diet rich in medium-chain triglycerides and olive oilas a supplement, and he also received chemotherapy (dexamethasone, cyclophosphamide, doxorubicin, vincristine), being discharged after the first cycle. Chemotherapy was scheduled to be administered every 3 weeks, and drainage thoracentesis were also scheduled to be performed during his probation period. After 5 months of treatment, bilateral chylothorax disappeared.

Quilotórax congénito: presentación de un caso / Congenital quilothorax: presentation of a case

Se presenta una paciente que presentó en el estudio ultrasonográfico prenatal efusión pleural bilateral. Posterior a su nacimiento se estableció el diagnóstico de quilotórax bilateral de etiología no determinada, limitándose el mismo con la terapéutica empleada en los primeros 7 días de vida. Se comentan sus principales manifestaciones clínicas, estudios para establecer el diagnóstico y tratamiento utilizado.

We present a patient who showed a bilateral pleural effusion at the prenatal ultrasonographic study. After she was born, the diagnostic was established: bilateral quilothorax of unknown etiology, limited with the therapy applied during the first 7 days of life. We state the main clinical manifestations, trials to arrive to a diagnostic and used treatment.

Quilotórax a tensión: reporte de dos casos / Tension chylothorax: two case reports

Thoracic duct injury is a well described entity as complication from cardiothoracic surgery. However tension chylothorax is rare, and may become a life-threating condition. Objective: To present 2 pediatric patients who developed hemodynamic and respiratory failures secondary to chylothorax. Patients: The first patient was a 2-month-old boy who developed chylothorax three weeks after a Norwood-Sano surgery; he showed a severe respiratory and hemodynamic collapse. The second patient was a one-month old baby who developed an acute respiratory failure and oliguria two days after a patent ductus arteriosus surgery. In both cases the chest tube placement resulted in the release of chyle under pressure and resolution of the symptoms. Conclusions: These two cases demostrate how chylothorax may provoke severe hemodynamic and respiratory effects. Early recognition and treatment of this condition is important for improved outcome.

El daño del ducto toráxico que ocasiona un quilotórax es una complicación bien conocida y documentada de las cirugías cardiotoráxicas. Sin embargo, el desarrollo de quilotórax a tensión es raramente reportado, siendo un evento que puede poner en riesgo la vida del paciente. Objetivo: Comunicar 2 pacientes, quienes presentaron compromiso hemodinámico y respiratorio de carácter grave, secundario al desarrollo de quilotórax. Casos: El primer paciente, de dos meses de edad, ocurrió luego de tres semanas de efectuarse una cirugía de Norwood-Sano, quien presentó un grave colapso ventilatorio y hemodinámico. El segundo paciente, de 1 mes de edad, desarrolló una falla respiratoria aguda y oliguria dos días posterior al cierre de un ductus arterioso persistente. En ambos casos la instalación de un tubo pleural resultó en la liberación de quilo a gran presión y una rápida resolución de los síntomas. Conclusión: Los dos casos aquí reportados evidencian que el quilotórax puede presentar efectos hemodinámicos y respiratorios deletéreos. El pronto reconocimiento y tratamiento de esta entidad son esenciales para el óptimo pronóstico del paciente.

Quilotórax / Chylothorax

O quilotórax, normalmente secundário a doenças malignas, trauma, doenças congênitas, infecções e trombose da veia cava superior, é uma causa pouco freqüente de derrame pleural. O diagnóstico e tratamento precoces são importantes no sentido de prevenir a mais temida conseqüência do quilotórax, a má nutrição e conseqüente comprometimento do estado imunológico.

Chylothorax, an uncommon cause of pleural effusion, is usually secondary to malignancy, trauma, congenital diseases, infections and superior vena cava thrombosis. The early diagnosis and treatment are important to prevent the most fearful consequence of chylothorax, the malnutrition with a compromised immunological status.

Quilotórax espontâneo associado a atividade física leve / Spontaneous chylothorax associated with light physical activity

O quilotórax ocorre quando há ruptura, laceração ou obstrução do ducto torácico, com liberação de quilo no espaço pleural. Pode acontecer em malformações linfáticas congênitas, linfomas, tumores de mediastino, doenças infecciosas, procedimentos cirúrgicos, traumas automobilísticos, ou ser idiopático. Apresenta sinais clínicos de dispnéia, hipotensão, edema generalizado e cianose. O diagnóstico geralmente é feito por toracocentese e o tratamento é conservador. O quilotórax espontâneo é uma condição incomum de derrame pleural, e somente é hipótese diagnóstica após a exclusão das demais causas. Descrevemos um caso de quilotórax espontâneo associado a atividade física leve em academia de ginástica.

Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct, resulting in the release of chyle into the pleural space. Chylothorax can occur in cases of congenital lymphatic malformation, lymphoma, mediastinal tumor and infectious disease, as well as during surgical procedures and after traffic accident-related trauma. It can also be idiopathic. The condition presents clinical signs of dyspnea, hypotension, generalized edema and cyanosis. The diagnosis is usually made through thoracocentesis, and the treatment is conservative. Spontaneous chylothorax is an uncommon form of pleural effusion, and its diagnosis should be hypothesized only after all other causes have been ruled out. Herein, we describe a case of spontaneous chylothorax associated with light physical activity at a fitness center.

Quilotórax congênito / Chylothorax congenital

O quilotórax é o derrame pleural mais frequente no feto e no neonato, ocorrendo em 1/10.00015.000 recém-nascidos. É potencialmente fatal devido ao acometimento respiratório, nutricional e imunológico. Este trabalho apresenta um caso de quilotórax congênito em lactente, no qual a recém-nascida apresentou derrame pleural congênito de etiologia desconhecida, drenado após o nascimento. Com um mês e cinco dias iniciou com cansaço às mamadas e taquipneia, e a radiografia de tórax demonstrou novo derrame. A lactente foi internada em Unidade de Terapia Intensiva Neonatal, para tratamento. Foi realizada drenagem torácica e confirmado o diagnóstico de quilotórax. O tratamento foi conservador, com resolução do quadro

Chylothorax is the most frequent pleural effusion in the fetus and newborn, occurring in 1/10.00015.000 newborns. It is potentially fatal due to respiratory, nutritional and immune system impairment. This paper presents a case of congenital chylothorax in a female infant who had congenital pleural effusion of unknown etiology, which was drained after birth. With one month and five days she began effortful breast feeding and tachypnea, and a chest X-ray showed a new effusion. The infant was admitted to the Neonatal Intensive Care Unit for treatment. Thoracic drainage was performed and the diagnosis of chylothorax was confirmed. Treatment was conservative with a good outcome

Quilotórax após o uso de artéria torácica interna esquerda na revascularizaçäo do miocárdio / Chylothorax after myocardial revascularization with the left internal thoracic artery

A 38-year-old male underwent coronary artery bypass grafting (CABG). A saphenous vein graft was attached to the left marginal branch. The left internal thoracic artery was anastomosed to the left anterior descending artery (LAD). The early recovery was uneventful and the patient was discharged on the 5th postoperative day. After three months, he came back to the hospital complaining of weight loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left pleural effusion. On physical examination, a decreased vesicular murmur was detected. After six days, the diagnosis of chylothorax was made after a milky fluid was detected in the plural cavity and total pulmonary expansion did not occur. On the next day, both anterior and posterior pleural drainage were performed by videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted for ten days. After seven days the patient was put on a low-fat diet for 8 days. The fluid accumulation ceased, the drains were removed and the patient was discharged with normal pulmonary expansion

Quilotórax asociado a adenocarcinoma de pulmón: presentación de un caso / Chylothorax associated to lung adenocarcinoma: presentation of a case

El quilotórax es la acumulación de fluidos ricos en triglicéridos en el espacio pleural. El diagnóstico es sugerido por la presencia de un fluido de aspecto lechoso con concentraciones de triglicéridos superiores a 110 mg/dL al realizar la trococéntesis o colocar el tubo de torocostomía y se ha asociado a enfermedades congénitas, trauma, lesiones intraoperatorias, enfermedades neoplásicas como lifosarcoma y menos frecuente por carcinoma broncogénico por invasión directa o embolia tumoral al conducto torácico. Se presentan los hallazgos clínicos radiológicos y quirúrgicos de una paciente con carcinoma broncogénico y quilotórax en quien se realizó ligadura del conducto torácico

Quilotórax traumático por ferimento penetrante do tórax / Traumatic chylothorax by Gunshot wound of thorax

The authors report two cases of traumatic chylothorax. They were caused by gunshot wounds producing thorax transfixing injuries and the chilothorax was subsequently diagnosed during the thoracic drainage follow-up, a chilous color was noticed in the drainage output. This was confirmed with a Sudam III stain. Both cases were treated conservatively with Total Parenteral Nutrition according to the current literature. One of the cases, in its evolution, required surgical treatment due to a persistent high output fistulae

Quilotórax en el período neonatal: caso clínico y revisión de la literatura / Chylothorax in the neonatal period: clinical case report and literature review

El quilotórax congénito es una de las causas más frecuentes de hidrotórax neonatal descartadas las causas inmunes, no inmunes e infecciosas. Puede ser causa de distress respiratorio y muerte en el período neonatal por hipoplasia pulmonar secundaria a una ocupación pleural importante. Su incidencia se estima muy baja, contribuyendo a esto el subdiagnóstico en los mortineonatos con hidrotórax, dado el aspecto aun no quiloso de la efusión. Este artículo reporta el caso de una recién nacida con diagnóstico antenatal de hidrotórax, que evolucionó en el período posnatal con progresión de la efusión pleural, concomitante a un aumento de volumen de sus extremidades inferiores. La punción de este líquido pleural resultó compatible con quilo y las imágenes de extremidades, con linfedema. Su estudio finalmente concluyó Enfermedad de Milroy-Meige. A partir de este caso se revisa la literatura existente discutiendo la fisiología, patogenia, clínica, diagnóstico y tratamiento del quilotórax congénito durante el período perinatal