Urological manifestations of the disease related to immunoglobulin G4.

Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.

La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.

Malformación vascular capilar y venosa en la mano. Reporte de caso de una extraña patología quirúrgica / Vascular capillary and venous malformation in the hand. Case report of a strange surgical pathology

Resumen Introducción: Las anomalías vasculares representan un amplio panorama de distintas lesiones donde los tumores son los más frecuentes. Las malformaciones vasculares suelen presentarse en etapas tardías de la vida secundarias al lento crecimiento y a los síntomas que padecen los pacientes. Debe de darse un manejo multidisciplinario donde el diagnóstico es la piedra angular. Los casos de malformaciones venosas o linfáticas suelen tratarse mediante la resección de la malformación en su totalidad. Presentación del caso clínico: Varón de 35 años de edad quién presenta aumento de volumen y dolor de 3 meses de evolución en la mano derecha. A la exploración física se observa una masa en la región tenar de dicha mano, con bordes bien definidos de aproximadamente 3 × 3 cm, no móvil, adherida a planos profundos, dolorosa a palpación, con hiperestesias en trayecto del nervio mediano. Se realizaron ultrasonido Doppler y resonancia magnética, los cuales sugirieron una lesión vascular. Se realizó exploración quirúrgica y se observó una lesión vascular adherida a las estructuras nerviosa y tendinosa, las cuales se liberaron y se extrajo la tumoración. Se envió la pieza quirúrgica a patología, que reportó hemangioma capilar y venoso. Conclusiones: Las malformaciones vasculares mixtas (venoso y capilar) en la mano son una entidad poco frecuente que requiere de un manejo quirúrgico preciso. Estas lesiones generan síntomas asociados al aumento de volumen, entre los que destacan: dolor, disminución del rango de movimientos. El tratamiento quirúrgico se asocia a una mejoría de los síntomas.

Abstract Introduction: Vascular anomalies in the hand represent a rare disease that needs an accurate diagnosis and prompt surgical treatment. One of the uncommon anomalies is the mixed vascular one. The diagnosis of these malformations is clinical but radiological studies such as magnetic resonance and Doppler ultrasound are mandatory. Once the diagnosis is made, surgery is the next and final step. Recurrence is rare when the entire tumor is resected. Clinical Case Study: A 35-year-old male presented with an increase in volume and pain of three months of evolution in the right hand. On physical examination, a mass in the righthand thenar region was observed, with well-defined edges of approximately 3 x 3 cm, not mobile, adhered to deep planes, painful to palpation, with hyperesthesias in the median nerve pathway. A magnetic resonance and a Doppler ultrasound were applied showing a well-circumscribed tumor. The patient underwent surgery and the whole vascular malformation was removed with no damage of neighbor structures. Pathology reported a venous and capillary hemangioma. Conclusions: Mixed vascular malformations in the hand are uncommon pathologies that require a correct diagnosis and a prompt surgical resolution. The most frequent symptoms associated with these tumors are: tenderness, pain and limitation in the movement of the hand. Surgical treatment is always recommended.

Urological manifestations of the disease related to immunoglobulin G4. / Manifestaciones urológicas de la enfermedad relacionada con la inmunoglobulina G4

Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.

La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.

Síndrome de onda J en paciente con quemadura eléctrica. ¿Causalidad o casualidad? / J wave syndrome in a patient with electrical burn. Causality or coincidence?

Resumen El corazón es uno de los órganos más vulnerables en la lesión inducida por electricidad. Pueden sobrevenir varias arritmias y manifestaciones electrocardiográficas de las que destacan asistolia, fibrilación ventricular, QT prolongado, bloqueo de rama derecha, bloqueo cardiaco completo, fibrilación auricular, bradicardia y extrasístoles auriculares y ventriculares, entre otras. El síndrome de onda J es un espectro de alteraciones eléctricas cardiacas que se distingue por la existencia de ondas J (ondas de Osborn) y riesgo elevado de fibrilación ventricular. Las afecciones que incluye este síndrome se distinguen por características comunes en lo referente a sus bases celulares y iónicas, factores de riesgo y patrones evolutivos. El objetivo de este artículo es describir el caso de un paciente que tuvo manifestaciones electrocardiográficas de síndrome de onda J asociado con quemadura eléctrica, su causalidad o casualidad y revisar la bibliografía relacionada con esta interesante entidad electrocardiográfica.

Abstract Heart is one of the most vulnerable organs in electrical injury. Various arrhytmias and electrocardiographic manifestations develop at the time of injury, these include asystole, ventricular fibrillation, QT-prolongation, right bundle branch block, complete AV block, auricular fibrillation, bradicardia and ventricular extrasystoles. J wave syndrome is a spectrum of electrical cardiac alterations characterized by the appearance of J waves (Osborn wave) with a risk of ventricular fibrillation. These entities share a similar ionic and cellular basis, risk factors and similar outcomes. The aim of this report is to describe a 23-year old patient who developed J wave syndrome associated to electrical injury, its causality or fortuity and review the literature related to this interesting electrocardiographic entity.

Alteraciones de la hemostasia en el enfermo con quemaduras / Hemostasis alterations in the patient with burns / Alterações da hemostasia no paciente com queimadura

Resumen: Las quemaduras graves se asocian a coagulopatía, que semeja a la que se presenta en trauma y sepsis. Se caracteriza por un desbalance procoagulante-anticoagulante e hiperactividad del sistema fibrinolítico. Es secundaria a hemodilución, hipotermia, inflamación, hipoperfusión tisular y lesión endotelial. La presencia de coagulopatía es un factor de riesgo en el incremento de morbimortalidad. A pesar de estar bien reconocida, no hay guías específicas para su abordaje y tratamiento, pero se han propuesto diferentes medidas y esquemas terapéuticos guiados por objetivos, semejantes a los recomendados para la coagulopatía en trauma.

Abstract: Severe burns are associated with systemic coagulopathy that resembles those found in patients with sepsis or major trauma. It is characterized by procoagulant-anticoagulant imbalance and hyperactivity of the fibrinolytic system. It is secondary to hemodilution, hypothermia, inflammation, hypoperfusion and endothelial injury. Burn coagulopathy is associated with increased morbidity and mortality. Even when recognized, there are no guidelines for the specific management of coagulopathy in burns, but supportive measures and targeted treatments, like in trauma coagulopathy, have been proposed.

Resumo: As queimaduras graves estão associadas com a coagulopatia. Assemelha-se aquele apresentado em trauma e sepse. Se caracteriza por um desequilíbrio de procoagulante-anticoagulante e hiperatividade do sistema fibrinolítico. É secundária à hemodiluição, hipotermia, inflamação, hipoperfusão tecidual e lesão endotelial. A presença de coagulopatia é fator de risco para o aumento da morbimortalidade. Apesar de ser bem reconhecida não existem orientações específicas para a sua abordagem e tratamento, mas foram propostas diferentes medidas e esquemas terapêuticos guiados por objetivos, semelhantes às recomendadas para a coagulopatia no trauma.

[Elena de Cespedes: The eventful life of a XVI century surgeon]. / Elena de Céspedes. La azarosa vida de una cirujana del siglo XVI.

Throughout the history of surgery there have been exceptional cases of surgeons around the world. One of them is Elena/o of Cespedes. Born as a girl, this hermaphrodite dedicated all his life to acting as a man, doing jobs that were only for men such as a soldier, peasant, and surgeon. She was the first licensed surgeon in Spain and maybe in all Europe. She married a woman and then was tried for sodomy by the Spanish Inquisition commanded by inquisitor Lope de Mendoza. She was founded guilty and punished with 200 lashes and a 10-year service at a hospital, dressed as a woman.

[Andres Vesalio, Francisco Díaz, Miguel de Cervantes Saavedra and the birth of urology in the 16th Century]. / Andrés Vesalio, Francisco Díaz, Miguel de Cervantes Saavedra y el nacimiento de la urología en el siglo XVI.

In the sixteenth century there were great advances in science, literature, and the arts. During this century, urology as a specialty was conceived, thanks to the contributions of Andreas Vesalius, anatomist and leading physician to the court of Charles V, and Dr. Francisco Diaz, a native of Alcala de Henares, surgeon and clinician. Dr. Diaz had a close relationship with Miguel de Cervantes, who at one point in his life suffered from renal colic. In his masterpiece "Re-Printed Treaty of all diseases of the kidneys, bladder and wattles of the Cock and Urina, divided into three books," of which the first book of urology is the History of Medicine, describes in detail the clinical and therapeutic aspects of urological diseases, known as the "bad stone" and urethral strictures known as "wattles", in addition to describing the different surgical techniques and the development of new instruments for urological procedures, which include the cisorio instrument and the Speculum pudendi. For the above, Dr. Francisco Diaz is considered the father of urology.

Síndrome de sepsis grave postesplenectomía secundario a meningococcemia / Overwhelming postsplenectomy infection (OPSI) syndrome secondary to meningococcemia

Resumen Los pacientes esplenectomizados o con hipoesplenia son susceptibles a desarrollar infecciones y sepsis grave. A esta entidad se le denomina sídrome de sepsis postesplenectomía (SSPE). Reportamos el caso de una paciente que presentó SSPE secundario a Neisseria meningitidis serogrupo CR7, 10 años después de practicársele esplenectomía por púrpura trombocitopénica idiopática. El SSPE tiene una elevada mortalidad, su evolución es fulminante, las manifestaciones son graves y el pronóstico es malo. Es fundamental que los pacientes esplenectomizados sean vacunados, reciban antibióticos profilácticos y atención médica ante cualquier manifestación de un proceso infeccioso. Es prioritario implementar una política de salud pública para el desarrollo de guías relacionadas al seguimiento de los pacientes esplenectomizados y sobre la profilaxis, diagnóstico y manejo del SSPE, y difundir entre los pacientes esplenectomizados y con disfunción esplénica así como al grupo médico tratante programas educacionales relacionados con esta enfermedad.

Abstract Patients with splenectomy or splenic dysfunction are likely to suffer from severe infections and sepsis. This syndrome is called overwhelming postsplenectomy infection (OPSI). We present the case of an adult who developed OPSI syndrome secondary to Neisseria meningitidis serogroup CR 7, ten years after being splenectomized due to idiopathic thrombocytopenic purpura. OPSI syndrome has a high mortality. Its course is fulminating, the clinical symptoms are serious and the prognosis is poor. It is important for splenectomized patients to receive immunizations, antibiotic prophylaxis and seek medical attention at the earliest sign of minor infection. Public health politics should be implemented for the development of guidelines related to the monitoring of splenecto-mized patients and prophylaxis, diagnosis and treatment of OPSI syndrome and make reliable information on this disease available to patients and physicians.

[Ultrasonographic evaluation of the diameter of the optic nerve sheath for medication of intracranial pressure: a case report]. / Evaluación ultrasonográfica del diámetro de la vaina del nervio óptico (DVNO) para la medición de la presión intracraneana (PIC): a propósito de un caso.

The main complication associated with acute brain injury is the elevation of intracranial pressure (ICP) and it is associated with high morbidity and mortality. In these patients, multimodal neurological monitoring has emerged as a fundamental tool in the intensive care unit, with the minimally invasive trend seen in recent years. We report the case of a patient in which ICP monitoring was based on the measurement of the diameter of the optic nerve sheath (DONS), a procedure that has shown a good correlation with the ICP, as well as a high specificity, sensitivity, and low cost.

La importancia de los parámetros farmacocinéticos y farmacodinámicos en la prescripción de antibióticos / The importance of pharmacokinetic and pharmacodynamic parameters in antibiotic prescription

En el tratamiento del enfermo grave, la elección del antibiótico y su dosificación están determinados por factores relacionados al microorganismo, al fármaco y a las condiciones de salud del paciente. La relación de algunos parámetros farmacocinéticos y farmacodinámicos como la concentración máxima alcanzada (Cmáx), el área bajo la curva (ABC) y la concentración mínima inhibitoria (MIC) son determinantes en la toma de decisiones para seleccionar el fármaco y su posología. De acuerdo a estos parámetros, los antibióticos se clasifican en dependientes de tiempo y dependientes de concentración. Los primeros (betalactámicos, glucopéptidos) pueden requerir ajustes en el tiempo de infusión y los dependientes de concentración (aminoglucósidos, fluoroquinolonas) se basan en la Cmáx/MIC.

In the treatment of critically ill patient, antibiotic choice and dosage are influenced by factors related to the pathogen, the drug and the patient's health status. The relationship of pharmacokinetic and pharmacodynamic parameters such as maximum concentration (Cmax), area under the curve (AUC) and minimum inhibitory concentration (MIC) can assist in decision-making to choose the drug and the correct dose. According to these parameters, antibiotics are classified into time-dependent and concentration-dependent. The first ones (betalactams, glycopeptides) could require adjustments in the infusion time; while concentration-dependent ones (aminoglycosides, fluoroquinolones) are based on the Cmax / MIC.

[Hemolytic anemia secondary to the placement of a portosystemic stented shunt]. / Anemia hemolítica secundaria a la colocación de Stent transyugular intrahepático porto sistémico.

INTRODUCTION: portal hypertension and variceal hemorrhage are common complications of hepatic cirrhosis, both associated with a high morbimortality. Portal system decompression by the placement of a transjugular intrahepatic portosystemic stented shunt, can reduce portal venus pressure and is effective controling complications of portal hypertension, like variceal hemorrhage and ascitis. The aim of this document is to describe a case of hemolytic anemia secondary to the placement of a transjugular intrahepatic portosystemic stented shunt. CLINICAL CASE: patient with portal hypertension secondary to liver cirrosis was given a transjugular intrahepatic portosystemic stented shunt for recurrent variceal hemorrhage. After the procedure, hemoglobin decreased 2 g/dL, associated with reticulocitosis, hipohaptoglobinemia, elevated lactic dehydrogenase and indirect hyperbilirrubinemia with negative Coombs test. The peripheral blood smear showed abnormal erythrocytes, with the prevalence of schistocytes. The final diagnosis was hemolytic anemia secondary to transjugular intrahepatic portosystemic stented shunt. CONCLUSIONS: the hemolytic anemia secondary to Transjugular Intrahepatic Portosystemic Stented Shunt is a rare complication. Usually, it has a benign prognosis, and it is self-limited once the stent is endothelialized.

[Liver abscess syndrome with lung involvement secondary to hypermucoviscosity Klebsiella pneumoniae]. / Síndrome de absceso hepático secundario a Klebsiella pneumoniae hipermucoviscosa con involucro pulmonar.

Klebsiella pneumoniae liver abscess syndrome (KLAS) is an emerging infection characterized by primary monomicrobial liver abscess, bacteremia and metastatic complications. KLAS is endemic in Taiwan but additional cases has also been described in other world regions. It's caused by strains of K. pneumonia serotype K1, rmpA, magA positive, displaying hypermucoviscosity. We present the case of a previously healthy 69 years old patient who developed fever, liver abscess,septic shock, bacteremia, and pneumonia. In cultures grew hypermucoviscous phenotype of K. pneumonia characterized by positive "string test". The patient responded favourably to antibiotic therapy with ceftriaxone, meropenem, amykacin and percutaneous drainage of the abscess. Increased awareness about this globally emerging infection by physicians could allow earlier detection and optimal treatment.

Síndrome serotoninérgico / Serotonin syndrome

El síndrome serotoninérgico (SS) se caracteriza por la presencia de disfunción autonómica, deterioro neuromuscular y alteraciones en el estado mental. El diagnóstico es clínico y por laboratorio. El tratamiento es mediante medidas de apoyo a base de líquidos, hipotermia, benzodiacepinas y, cuando lo amerite, intubación y ventilación mecánica. El pilar de la intervención farmacológica es ciproheptadina, un antagonista central H1, con un antagonismo periférico 5-HT2A. El medicamento disponible sólo se puede administrar por vía oral, por lo que en enfermos críticos debe administrarse a través de sonda nasoyeyunal. El objetivo de este trabajo es presentar un caso de SS y revisar la literatura al respecto.

The serotonin syndrome (SS) is characterized by a spectrum of signs characterized by autonomic dysfunction, neuromuscular impairment, and alterations in mental status. The diagnosis of the serotonin syndrome is clinical and by laboratory evaluation. Treatment is with active cooling and benzodiazepines to control agitation, and intubation, especially in patients with severe hyperthermia and delirium. The mainstay of pharmacologic intervention is cyproheptadine, a centrally acting H1-antagonist, with a prominent peripheral 5-HT2A antagonism. The drug is only available orally, and if the patient is unable to swallow, the drug should be administered nasogastrically. The objective of this paper is report a case of Serotonin Syndrome and review the literature related to this disease.

Alteraciones electrocardiográficas en hemorragia subaracnoidea / Electrocardiographic alterations in subarachnoid hemorrhage

Los enfermos con hemorragia subaracnoidea (HSA) presentan con frecuencia alteraciones electrocardiográficas (ECG), las más frecuentes son alargamiento del segmento QT, ondas T negativas, elevación o inversión del segmento ST y ondas U. La inversión de las ondas T asociada a la prolongación del QT se correlaciona con alteraciones de la contractilidad ventricular y es una indicación para practicar ecocardiograma. Se reporta el caso de un paciente con HSA secundaria a ruptura de aneurisma intracraneal que presentó cambios electrocardiográficos, enfatizando en la patogénesis de éstos y el impacto que tienen en el comportamiento clínico y la evolución.

Electrocardiographic (EGC) changes have been frequently observed in patients with subarachnoid hemorrhage (SAH). The most frequent anomalies reported are prolonged of the QT interval, negative T waves, elevation or inversion of the ST segment and U wave. T wave inversion associated to QT interval prolongation is related to alterations in ventricular contraction indicating that echocardiographic screening is required. We report the case of a patient with SAH secondary to intracranial aneurism rupture who showed electrocardiographic changes, emphasizing the pathogenesis of the latter and the impact they have in both clinical manifestations and evolution.

[Libman-Sacks endocarditis]. / Endocarditis de Libman-Sacks.

In 1924, Libman and Sacks described valvular lesions in patients with lupus erythematosus. Libman-Sacks valvular lesions are sterile fibrinous vegetations that preferentially develop at the left-sided heart valves. Reports of their prevalence range from 53 to 74%. Libman-Sacks endocarditis is associated with disease activity and antiphospholipid antibodies titer. Echocardiography is a useful tool for documenting valvular involvement and dysfunction as well as disease progression. Transesophageal echocardiography is superior to transthoracic echocardiography in detecting Libman-Sacks endocarditis. This report describes the echocardiographic image of Libman-Sacks endocarditis in a patient with active lupus erithematosus.

Endocarditis de Libman-Sacks / Libman-Sacks endocarditis

Libman y Sacks describieron por primera vez en 1924 la presencia de lesiones valvulares en enfermos con lupus eritematoso. La endocarditis de Libman y Sacks se caracteriza por vegetaciones estériles valvulares de predominio en las válvulas mitral y aórtica. Su prevalencia es de 53 a 74 %. Se asocia con actividad lúpica y presencia de anticuerpos antifosfolípido. La ecocardiografía, en especial la transtorácica, es el estudio de elección para el diagnóstico y seguimiento, así como para evaluar el involucro valvular. El objetivo de este trabajo es presentar la imagen ecocardiográfica de un enfermo con lupus eritematoso activo portador de endocarditis de Libman-Sacks.

In 1924, Libman and Sacks described valvular lesions in patients with lupus erythematosus. Libman-Sacks valvular lesions are sterile fibrinous vegetations that preferentially develop at the left-sided heart valves. Reports of their prevalence range from 53 to 74%. Libman-Sacks endocarditis is associated with disease activity and antiphospholipid antibodies titer. Echocardiography is a useful tool for documenting valvular involvement and dysfunction as well as disease progression. Transesophageal echocardiography is superior to transthoracic echocardiography in detecting Libman-Sacks endocarditis. This report describes the echocardiographic image of Libman-Sacks endocarditis in a patient with active lupus erithematosus.

Quilotórax secundario a herida por proyectil de arma de fuego / Chylothorax secondary to gunshot wound

Introducción: El quilotórax es la presencia de quilo en el espacio pleural secundaria a lesión u obstrucción del conducto torácico. Su etiología puede ser traumática o no traumática. El aspecto lechoso del líquido pleural y su alto contenido de triglicéridos orientan el diagnóstico. El objetivo de este trabajo es presentar un caso de quilotórax secundario a herida por proyectil de arma de fuego y revisar los conceptos actuales y opciones terapéuticas. Caso clínico: Paciente de 33 años que presentó quilotórax secundario a herida por proyectil de arma de fuego. Se manejó a base de ayuno, alimentación parenteral y drenaje pleural. Su evolución fue satisfactoria. Conclusiones: El quilotórax es una entidad asociada a elevada morbilidad y mortalidad. Su diagnóstico temprano y oportuno, como en el paciente descrito, es fundamental para asegurar la evolución satisfactoria.

BACKGROUND: Chylothorax is the occurrence of chyle in the pleural space due to damage or obstruction of the thoracic duct. Its etiology can be traumatic or nontraumatic. Traumatic lesion of the thoracic duct occurs after accidents or cardiothoracic surgery. Non-Hodgkin's lymphoma is the most frequent nontraumatic etiology. Milky aspect and high content of triglycerides in pleural fluid confirm the diagnosis. The objective of this paper is to present a case of chylothorax secondary to shotgun lesion as well as to review current concepts about chylothorax and its treatment. CLINICAL CASE: We present the case of a 33-year-old male patient with chylothorax secondary to gunshot lesion. Management was based on fasting, parenteral nutrition and pleural drainage. Patient's evolution was satisfactory. CONCLUSIONS: Chylothorax is an entity associated with high morbidity and mortality. Early diagnosis and appropriate treatment are essential.

Chylothorax secondary to gunshot wound.

BACKGROUND: Chylothorax is the occurrence of chyle in the pleural space due to damage or obstruction of the thoracic duct. Its etiology can be traumatic or nontraumatic. Traumatic lesion of the thoracic duct occurs after accidents or cardiothoracic surgery. Non-Hodgkin's lymphoma is the most frequent nontraumatic etiology. Milky aspect and high content of triglycerides in pleural fluid confirm the diagnosis. The objective of this paper is to present a case of chylothorax secondary to shotgun lesion as well as to review current concepts about chylothorax and its treatment. CLINICAL CASE: We present the case of a 33-year-old male patient with chylothorax secondary to gunshot lesion. Management was based on fasting, parenteral nutrition and pleural drainage. Patient's evolution was satisfactory. CONCLUSIONS: Chylothorax is an entity associated with high morbidity and mortality. Early diagnosis and appropriate treatment are essential.