1/13. Infected chylothorax caused by streptococcus agalactiae: a case report.chylothorax is bacteriostatic in nature. Bacterial infection rarely develops in chylothorax and has never been reported in a non-immunocompromised host. A 33-year-old woman was admitted to National taiwan University Hospital because of fever and right pleuritic pain. Chest roentgenography and computed tomography revealed right pleural effusion. Examination of the pleural effusion revealed a profile compatible with empyema and chylothorax. culture of the pleural effusion yielded streptococcus agalactiae. The woman was not immunocompromised. This is the first report of infected chylothorax caused by streptococcus agalactiae in a non-immunocompromised host.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/13. chylothorax in chronic lymphocytic leukemia patient.Chronic lymphocytic leukemia (CLL) is rarely complicated by chylothorax: we present a 93-year-old woman with CLL who developed recurrent pleural effusions that were ultimately found to be chylous in nature. Despite eight repeated thoracenteses, she continued to experience re-accumulation of fluid, and therefore, video-assisted thoracotomy with mass ligation of the thoracic duct region plus pleurodesis was performed to resolve the chylothorax. Despite her age and underlying disease, she did well during follow-up. The etiology and management of chylothorax are also reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/13. Diffuse lymphangiomyomatosis.A case of diffuse lymphangiomyomatosis with involvement of the large veins of the body is reported. The clinical, pathologoanatomic and especially the roentgenologic findings are described. Interstitial lung thickening, pleural effusions and spontaneous pneumothorax are findings which together with a stasis in the lymphatic system strongly suggest the diagnosis. The extensive involvement of the venous system supports the theory of a hamartomatous nature of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/13. Chylous effusions complicating lymphoma: a serious event with octreotide as a treatment option.Chylous effusions have an identical appearance to milk and occur when the thoracic duct is blocked. Since chyle represents direct absorption of fat from the small intestine lacteals, it is rich in fat, calories, vitamins and immunoglobulins. drainage of this milk-like fluid from any cavity (chest or abdomen) results in rapid weight loss and profound cachexia. The recognition of this milk-like fluid as chyle is urgent for the implementation of the correct treatment. In adults, lymphoma is one of the commonest malignancies to cause blockages in the thoracic duct. Once the diagnosis is made, conservative treatment with strict dietary adjustment often fails to prevent weight loss or resolve the underlying cause. Since the condition is uncommon, no guidelines exist. Many surgeons recommend early surgical intervention before the patient becomes too weak. Surgery may also fail. We report the case of a 62-year-old man with chylous effusions and a weight loss of 30 kg. The nature of the effusion was unrecognized for the first 16 weeks. Upon diagnosis, dietary adjustment was made and a lymphangiogram organized with a view to surgery. literature searches revealed two cases in which somatostatin was used after surgical procedures failed. We therefore used octreotide (a synthetic analogue of somatostatin). We report complete resolution of the condition within 72 h leading to the resumption of a normal diet and discharge within 2 weeks.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/13. Transudative chylothorax: report of two cases and review of the literature.Transudative chylothorax is a rare entity that has been associated with a limited range of clinical settings. To date, transudative chylothoraces have been described in only 13 patients, most commonly as a result of hepatic cirrhosis. Recognition of the transudative nature of these effusions is important to avoid unnecessary diagnostic testing and inappropriate management strategies. This report describes the presentation, diagnosis and management of two patients with transudative chylothoraces, and provides a brief review of the relevant literature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/13. chylothorax as a possible diagnostic pitfall: a report of 2 cases with cytologic findings.BACKGROUND: Chyothorax is an uncommon medical condition. To the best of our knowledge, there have been no detailed English-language report dealing with its cytopathologic findings and diagnostic pitfalls CASES: A 12-year-old boy, hemodialysis dependent, with congenital nephrotic syndrome due to focal segmental glomerular sclerosis and a failed renal transplant, developed shortness of breath. Physical and radiologic examinations revealed a left pleural effusion. A 7-year-old boy developed shortness of breath, with a subsequent finding of a left pleural effusion. Multiple osteolytic skeletal lesions were found in this patient. Both patients underwent thoracocentesis. Cytologically, both fluids contained many relatively uniform, large lymphoid cells with high nuclear/cytoplasmic (N/C) ratio, condensed chromatin and occasional nucleoli, resembling blasts. Some nuclei were convoluted. Mitotic figures were present. Foamy macrophages were present in both cases. The differential diagnosis of these populations of cells included a lymphoproliferative disorder. However, the mature T-lymphocytic nature of the cells was confirmed by immunohistochemistry performed on cell block preparations, confirming the clinical impression of chylothorax in both cases. The first patient had chylothorax as a result of trauma due to therapeutic interventions (subclavian vein cannulation), in the second patient the chylothorax was a part of Gorham-Stout syndrome. CONCLUSION: The large t-lymphocytes that are the major cellular component of chylothorax may arouse suspicion of a lymphoproliferative disorder. attention to the clinical history and immunophenotyping confirm the benign nature of the pleural space fluid. Also, abundant foamy macrophages can be considered a low-power clue to this diagnosis.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
7/13. Pediatric adrenal cortical carcinoma: brain metastases and relationship to NF-1, case reports and review of the literature.Adrenal cortical carcinoma (ACC) is a rare childhood neoplasm that seldom manifests brain metastases; hence few papers in the literature focus on neurological manifestations associated with ACC. Although ACC is known to be a signature tumor type in several inherited cancer predisposition syndromes, particularly Li Fraumeni, ACC has not been previously associated with neurofibromatosis, type 1 (NF-1), an inherited disorder with frequent CNS lesions that might prompt concern for metastatic disease by neuroimaging studies. We present two pediatric patients with ACC and unusual CNS findings. The first child developed metastasis to the brain 4 years after resection of his adrenal primary and 2 and 1 years, respectively, after metastases to the liver and lungs. Soon after our experience with this patient, a girl with known NF-1 presented with virilization; adrenalectomy disclosed an ACC and systemic metastases were found within months. Disseminated disease prompted concern that her complex intracranial lesions identified by neuroimaging studies might represent brain metastases, but this proved to be NF1-related hamartomatous lesions. We review the literature on ACCs in pediatric patients regarding brain metastases and previous associations with NF-1.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/13. chylothorax following innominate vein thrombosis: a rare complication of transvenous pacemaker implantation.A case of chylothorax following innominate vein thrombosis, which developed as a late complication of transvenous pacemaker implantation, is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. The aetiological workup showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge this is the first report of a case of this nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/13. Generalised lymphangiomatosis with chylothorax.A 9 month old boy presented with acute respiratory distress and was found to have a left pleural effusion. The chylous nature of the effusion, multiple bony lytic lesions, and splenic cysts lead to the diagnosis of congenital lymphangiomatosis with chylothorax. Surgical intervention including pleurectomy was required after unsuccessful conservative management.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/13. Lymphaticopleural fistula: diagnosis by computed tomography.A case of lymphaticopleural fistula demonstrated by CT following lymphography is presented. Computed tomography can depict the course and location of the fistula as well as the chylous nature of the effusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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