ABSTRACT
Chylothorax and chylous ascites are an accumulation of fluid containing a large proportion of triglycerides. The presence of these two effusions simultaneously is rare. A case of a patient with a known history of cirrhosis, hospitalized for an ascetic decompensation with left pleural effusion is herein presented. The woman was diagnosed as presenting both chylous ascites and chylothorax. Both fluids are transudate type fluids. After evacuation of the fluids and implementation of an adapted treatment neither effusion reappeared. The patient has been followed for the past year and has not shown any signs of relapse. Chylothorax, in cirrhotic patients is due to trans-diaphragmatic passage of fluid originating from the chylous ascites. Both extravasations have the same biological characteristics.
Subject(s)
Chylothorax/etiology , Chylothorax/pathology , Liver Cirrhosis/complications , Chylothorax/therapy , Drainage , Female , Humans , Middle Aged , Pleural Effusion/etiology , Pleural Effusion/therapyABSTRACT
We report two cases of spontaneous esophageal intramural dissection in two women aged 65 and 79 years. Initial symptoms were a constrictive retrosternal thoracic pain during a meal. Minor hematemesis accompanied by dysphagia or odynophagia appeared during the following hours. After excluding a cardiovascular emergency, diagnosis was confirmed by upper GI endoscopy that found a large mucosal longitudinal dissection; the lesion extended from mid-esophagus until short above the gastro-esophageal junction. Intramural parietal dissection characteristically appeared on barium swallow as a "double-barrelled" esophagus related to a thin radiolucent mucosal membrane separating the false and true lumens. Medical treatment with total parenteral nutrition, intravenous gastric antisecretory drugs, antibiotics in 1 patient was continued until symptoms disappeared; oral feeding was then started without incident. Follow-up endoscopic examinations confirmed complete healing. Regardless of etiology which remains speculative, spontaneous intramural dissection of the esophagus probably results from an intramural hematoma in most cases.
