1/38. Spontaneous chylothorax associated with primary lymphedema and a lymphangioma malformation.Spontaneous chylothorax associated with primary lymphedema is an exceedingly rare clinical entity. We report a case of chylothorax in a 38-year-old woman with a history of primary lymphedema of the right leg and an inguinal lymphangioma. Pathophysiology, diagnosis, treatment, as well as literature review are presented.- - - - - - - - - - ranking = 1keywords = edema (Clic here for more details about this article) |
2/38. chylothorax, chylopericardium and lymphoedema--the presenting features of signet-ring cell carcinoma.This report describes a patient with chylous pleural and pericardial effusions in conjunction with severe lymphoedema resembling elephantiasis. The chylous effusions and generalized lymphoedema were associated with a signet-ring cell carcinoma.- - - - - - - - - - ranking = 1keywords = edema (Clic here for more details about this article) |
3/38. Variable levels of mosaicism for trisomy 21 in a non-immune hydropic infant with chylothorax.We report the first case of mosaic trisomy 21 with non-immune hydrops fetalis and bilateral chylothoraces. Prenatal fetal blood karyotype analysis of 15 fetal cells revealed a 46,XX karyotype. Aggressive prenatal management, including fetal thoracocentesis and pleuro-amniotic shunt, was performed. A clinical phenotype of down syndrome was apparent after the gross oedema had subsided. Subsequent chromosome study of neonatal blood lymphocytes showed mosaic trisomy 21 with 23 per cent trisomic cells. review of the initial fetal blood sample identified trisomy in 5 per cent of 134 cells. Follow-up study at five months showed no trisomy 21 in 100 cells. This case illustrates the variable levels of mosaicism manifest in the peripheral blood of an infant with obvious down syndrome phenotype, and the limitation of cytogenetic analysis of peripheral lymphocytes alone in prenatal and postnatal detection of low levels of mosaicism.- - - - - - - - - - ranking = 103.26306105409keywords = hydrops, edema (Clic here for more details about this article) |
4/38. Management of acute chylothorax with hydrops fetalis diagnosed in the third trimester of pregnancy.A fetus with large pleural effusion and hydrops fetalis diagnosed in the third trimester was successfully treated with prompt vaginal delivery followed by drainage of the pleural cavity, after confirmation of congenital chylothorax and re-expansion of the lung with prenatal thoracentesis.- - - - - - - - - - ranking = 515.4819719371keywords = hydrops (Clic here for more details about this article) |
5/38. Congenital chylothorax in neonatal thyrotoxicosis.We report a patient with congenital chylothorax who also had neonatal thyrotoxicosis secondary to maternal Graves' disease. Fetal tachycardia with hydrops was detected at 28 weeks' gestational age. The fetus responded to antithyroid medication in utero but had persistent bilateral pleural effusion. At birth, he had respiratory distress due to massive pleural effusion. Cytologic studies of pleural fluid were consistent with chylothorax. To the best of our knowledge, the association of congenital chylothorax with fetal (neonatal) thyrotoxicosis, has not been reported previously.- - - - - - - - - - ranking = 103.09639438742keywords = hydrops (Clic here for more details about this article) |
6/38. Severe hypoproteinemia in a fetus after pleuro-amniotic shunts with double-basket catheters for treatment of chylothorax.The prognosis of a fetus with hydrothorax at mid-trimester is extremely poor. We encountered a fetus who developed bilateral chylothoraxes at 23 weeks of gestation. Bilateral pleuroamniotic shunts with double-basket catheters were successfully installed at 25 weeks of gestation. hydrothorax did not recur in this fetus. After the shunting, however, polyhydroamnios, fetal hypoproteinemia, and placental edema developed, and the hydrops worsened. The drainage of the fetal pleural effusion into the amniotic cavity was believed to have contributed to these complications. The infant, born at 29 weeks of gestation, died of cardiac failure and pulmonary hypoplasia. Thus, the shunts did not ameliorate the adverse conditions in this patient.- - - - - - - - - - ranking = 103.26306105409keywords = hydrops, edema (Clic here for more details about this article) |
7/38. A case of successful fetal therapy for congenital chylothorax by intrapleural injection of OK-432.A 38-year-old multiparous woman was referred at 19 weeks' gestation because of hydrops fetalis. Ultrasonic examination revealed severe pleural effusion, ascites and skin edema. Detailed examination of the amniotic fluid, fetal blood and intrathoracic fluid led to a diagnosis of congenital fetal chylothorax. Repeated thoracocenteses were not effective in improving the hydrops fetalis. We introduced fetal treatment for the pleural effusion by an intrapleural injection of OK-432 at 23, 24 and 25 weeks' gestation. The pleural effusion was reduced by adhesion of the intrathoracic space and resulted in the delivery of a neonate who was healthy except for right renal dysfunction. Pulmonary hypoplasia was successfully prevented by OK-432.- - - - - - - - - - ranking = 206.35945544151keywords = hydrops, edema (Clic here for more details about this article) |
8/38. Lymphogenous cyst-vein shunt in the management of chylothorax and chylorrhea.A 36 year-old woman developed marked lymphedema and chylous cysts of the lower abdominal wall, groin, labia, accompanied by chylorrhea. After cyst excision and transplantation of the greater omentum, a left chylothorax occurred. After thoracic duct ligation and left pleurodesis, pleural effusion recurred and worsened. Lymphangioscintigraphy and conventional lymphography suggested that undrained enlarged retroperitoneal lymphatics in the right iliac fossa had disrupted and lymph had leaked into the left chest from the right iliac fossa. Treatment by a lymphatic cyst-vein anastomosis redirected excess chylous lymph into the blood circulation and chylothorax initially remitted. Several years later with recurrence of chylorrhea, the anastomosis was found to be occluded. After a second operative connection between a lymphogenous cyst and the greater saphenous vein, chylorrhea subsided and chylothorax has remitted for more than 4 years.- - - - - - - - - - ranking = 0.16666666666667keywords = edema (Clic here for more details about this article) |
9/38. Treatment of severe fetal chylothorax associated with pronounced hydrops with intrapleural injection of OK-432.We describe a case of a 25-week fetus with severe bilateral pleural effusion, marked ascites, skin edema, an anterior thick (hydropic) placenta and polyhydramnios in which the most probable diagnosis was congenital chylothorax. Treatment with a pleuroamniotic shunt was planned, however the location of the fetus just below the anterior placenta made the placement of the shunt too dangerous. We therefore decided to use intrapleural injection of OK-432. From week 29, the lungs looked normal, the pleural effusion had resolved and the thoracic circumference was within normal limits. The severe ascites persisted throughout the pregnancy and a total volume of 3680 mL was removed on several occasions. A cesarean section was performed at 38 weeks and a normal male was delivered. continuous positive airway pressure was needed on the first 4 days but after a week the situation was stable. On day 8, an X-ray showed normally developed lungs. OK-432 appears to have prevented pulmonary hypoplasia in our patient.- - - - - - - - - - ranking = 412.55224421634keywords = hydrops, edema (Clic here for more details about this article) |
10/38. drainage of subcutaneous lymphatic fluid for the management of respiratory distress in a case of generalized lymphangiectasia in an infant.A 10-month-old girl was referred to our hospital because of congenital and persistent bilateral chylothorax and generalized lymphedema as well as long-standing respiratory disturbance. Radiological studies showed a diffuse network of superficial lymphatic vessels without major trunks throughout her entire body as well as the lung. She was diagnosed with systemic lymphangiomatosis complicated with pulmonary lymphangiectasia. Percutaneous puncture in the lower leg was performed to discharge the lymphatic fluid and proved to be effective for the respiratory disturbance. This procedure is safe and easy and effectively improves the quality of life of the patient and the family in case of such a persistent disease.- - - - - - - - - - ranking = 0.16666666666667keywords = edema (Clic here for more details about this article) |
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