[Chylous ascites complicating domiciliary ventilation by tracheostomy]

Despite the development of non-invasive ventilation there remain indications for domiciliary ventilation by tracheostomy (TDV). The principal complications are mechanical and infective. We report a case of chylous ascites secondary to compression of the thoracic duct by the tracheostomy cuff.

A man of 65 had had TDV for over one year. During hospitalisation for possible weening chylous ascites was discovered. The classical causes of this condition were excluded. CT scan of the neck and thorax showed evidence of significant dilatation (over 45 mm) of the upper part of the trachea in association with an over-inflated cuff, leading to compression of the thoracic duct. On reducing the inflation pressure of the cuff the chylous ascites has not recurred.

The management of the tracheostomy tube cuff is an important matter for the personel involved in the management of TDV. Regular radiological surveillance is useful to ensure that there is no tracheal dilatation in association with the cuff.