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Spontaneous cervical chyle fistula: A case report.

Swathi Appachi1, Joseph B Meleca1, Paul C Bryson1

  • 1Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.

American Journal of Otolaryngology
|April 14, 2019
PubMed
Summary

This case report details the first known instance of a spontaneous cervical chyle leak in a patient without prior surgery. The condition, typically caused by injury, presented as neck swelling and was successfully treated with thoracic duct ligation.

Keywords:
Chyle leakChylous fistulaIdiopathicNecrotizing fasciitisSpontaneous

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Area of Science:

  • Vascular Surgery
  • Thoracic Surgery
  • Gastroenterology

Background:

  • Cervical chylous fistulae are rare, often resulting from iatrogenic thoracic duct injury.
  • Spontaneous chyle leaks in the neck are undocumented in patients with no surgical history.

Observation:

  • A 50-year-old female presented with progressive neck swelling and imaging revealed extensive infiltrative changes.
  • Intraoperative findings included milky fluid, confirmed as chyle, in the neck and retropharyngeal space.
  • Diagnostic imaging excluded malignancy, and a lymphangiogram identified dilated lymphatic vessels.

Findings:

  • The patient underwent successful thoracic duct ligation and biopsy, with pathology revealing benign lymph nodes.
  • Fluid analysis confirmed chylomicrons and elevated triglycerides (>2400 mg/dL).
  • The patient recovered with a low-fat diet and showed no signs of recurrence upon follow-up.

Implications:

  • This case establishes the possibility of spontaneous cervical chyle leaks.
  • It highlights the importance of considering non-iatrogenic causes for chylous fistulae.
  • Further research may elucidate the mechanisms behind spontaneous lymphatic vessel rupture.