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[Congenital and acquired chylothorax]
N Tommasoni1, G Mognato, P G Gamba
1Cattedra di Chirurgia Pediatrica, Azienda ospedaliera-Università di Padova.
Insights
Congenital and postoperative chylothorax in children can be managed conservatively. However, chylothorax associated with bone lymphangiomatosis requires prompt and aggressive surgical intervention for better outcomes.
Area of Science:
- Pediatric Thoracic Surgery
- Pediatric Critical Care Medicine
- Pediatric Oncology
Context:
- Chylothorax, a rare but serious condition in children, presents significant respiratory, nutritional, and immunological challenges.
- While often linked to trauma or tumors, chylothorax can occur idiopathically, sometimes associated with rare conditions like bone lymphangiomatosis.
- This study examines congenital and postoperative chylothorax in pediatric patients, including a unique case of massive chylothorax with extensive lymphangiomatosis.
Purpose:
- To review the diagnosis and management strategies for congenital and postoperative chylothorax in pediatric patients.
- To establish clinical guidelines based on literature review and institutional experience.
- To differentiate management approaches based on the presence or absence of associated conditions like bone lymphangiomatosis.
Summary:
- Conservative management (parenteral nutrition, chest tube) was successful in 6 of 7 postoperative chylothorax cases.
- Conservative treatment is effective for congenital chylothorax without bone lymphangiomatosis.
- Chylothorax associated with bone lymphangiomatosis necessitates an early and aggressive surgical approach.
Impact:
- Provides evidence-based guidelines for managing pediatric chylothorax, distinguishing between common and complex cases.
- Highlights the critical need for tailored treatment strategies based on underlying pathology.
- Aims to improve patient outcomes by advocating for timely and appropriate interventions in life-threatening pediatric conditions.
Background/Purpose:
Chylothorax in paediatric age is a life-threatening clinical entity that cause serious respiratory, nutritional and immunologic complications. Chylothorax in the absence of trauma or tumour is uncommon and lymphangiomatosis of the bone, although extremely rare, has been associated with these condition. The authors describe the case of a two-year-old girl who presented with a massive chylothorax associated with hip and paravertebral lymphangioma and spread lymphangiomatosis of the spine. The authors also review the literature and their experience of congenital and postoperative chylothorax in order to establish guidelines for the diagnosis and management of both primary and postoperative chylothorax in paediatric age.
Methods:
From 1990 and 1999, 14 children had chylothorax. 9 patients had pleural effusion after surgical procedure, 5 patients had congenital chylothorax (both in prenatal and neonatal time), one of whom with bone lymphangiomatosis associated.
Results:
Postoperative chylothorax has been successfully treated by conservative approach (starvation, total parenteral nutrition and chest tube) in 6 out of 7 cases (two patients died because of complex cardiac malformation). Conservative approach is useful in case of congenital chylothorax, but not with bone lymphangiomatosis associated.
Conclusions:
Postoperative and congenital chylothorax is well managed with conservative treatment. Chylothorax with bone lymphangiomatosis associated needs early and aggressive surgical approach.