Refractory chylothorax after severe vomiting and coughing in a 4-year-old child

Abstract

Chylothorax is the accumulation of lymphatic fluid in the pleural space. It is a rare condition with potentially life-threatening disorders. In children, the etiology of chylothorax can be mainly attributed to idiopathic factors, congenital, miscellaneous, trauma and malignancies. Conservative treatments can solve most chylothorax, but refractory chylothorax can be challenging to manage. We herein present the case of a 4-year-old girl with no previous medical history who was admitted to our institution after severe vomiting and right chylothorax. The etiological assessment could not identify specific causes. Initial treatment was conservative but after 14 days, the patient showed no improvement. An exploratory thoracoscopy using indocyanine green showed no active leaks. Pleurodesis was performed and, later on, ligation of the ductus thoracicus. Hereafter, the patient progressed favorably. Even though conservative treatments of chylothorax show a high success rate, the efficacy of additional therapies and the benefits between surgical procedures need further investigation.

Figure 1

Lymphoscintigraphy: blue arrow indicates axillary lymph nodes, the red arrow shows the inguinal lymph nodes. They are no signs of tracers in the thorax cavity.

Figure 2

Lymphangiography: detection of lipiodol in the ductus thoracicus (blue arrow). The marker stops at the clipping of the ductus thoracicus. No leakage is detected.