1/13. Cytologic finding of chyloascites in lymphangioleiomyomatosis. A case report.BACKGROUND: lymphangioleiomyomatosis is a rare disease, histologically characterized by an abnormal proliferation of smooth muscle around the lymphatics. lung is the most common site of involvement, and patients usually present with dyspnea, chest pain, and cough. Chylous pleural effusion and ascites occasionally appear during the course of the disease. There are only a few reports on the cytologic findings in this disease. To our knowledge, the cytologic findings of chylous pleural effusion and chyloascites have not been reported before. CASE: A 23-year-old female presented with chylothorax, chyloascites and a retroperitoneal mass. Cytologic examination of chylous pleural effusion and chyloascites revealed numerous cohesive and thick clusters of cells with a high nuclear/cytoplasmic ratio, oval nuclei and slightly increased chromatin content. mitosis and necrosis were not observed. Exploratory laparotomy and transbronchial lung biopsy were performed, and the histologic diagnosis was lymphangioleiomyomatosis involving the retroperitoneal lymph nodes, uterine fundus and lungs. immunohistochemistry showed that the characteristic clusters in chylous fluids were positive for alpha-smooth muscle actin. CONCLUSION: A diagnosis of lymphangioleiomyomatosis is possible from cytologic findings of effusions with the aid of clinical findings.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/13. Isolated non-chylous pleural effusion in two neonates.Isolated pleural effusion, so called primary pleural effusion denotes a pleural effusion without documented etiology such as a cardiac, inflammatory, iatrogenic problem or fetal hydrops. Chromosomal anomaly such as down syndrome may be associated with isolated pleural effusion. The content of the isolated pleural effusion is mostly chylous, and isolated non-chylous pleural effusion in neonate is rare. We experienced 2 cases of isolated non-chylous pleural effusion. They had neither cardiac problem nor other sign of hydrops fetalis. Imaging diagnosis was done by plain chest radiography and subsequent ultrasonogram. One of them was diagnosed to down syndrome by karyotyping. They were fared well after diagnostic and therapeutic thoracentesis. We describe 2 cases of non-chylous pleural effusion and review a few English-language case reports of this entity.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/13. Postoperative chylous ascites: a rare complication of laparoscopic Nissen fundoplication.The accumulation of chylous fluid in the abdominal cavity is an infrequent, yet alarming, complication in abdominal surgery. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux disease and is significantly altering the balance of therapy toward more common and earlier surgical intervention. We report the case of a 67-year-old woman with gastroesophageal reflux disease and intense esophagitis who underwent a laparoscopic Nissen fundoplication in February 2000. The procedure was performed without apparent complications. Twenty days later, the patient complained of abdominal pain and distension. ultrasonography showed ascites, whereas endoscopic and radiological exploration of the fundoplication demonstrated no abnormalities. A paracentesis was performed, which showed a milky fluid with high concentrations of triglycerides (1024 ng/dL) and cholesterol (241 ng/dL). The patient was treated successfully with total parenteral nutrition for 3 weeks, followed by a low-fat diet. To our knowledge, this is the third reported case of chylous ascites after a Nissen fundoplication and the second case after laparoscopic fundoplication. The development of chylous ascites seems to be related to the injury of lymphatic vessels, including the thoracic duct, during the retroesophageal window dissection. The careful dissection and judicious use of diathermy is proposed to prevent this rare complication.- - - - - - - - - - ranking = 6.6618055857862keywords = abdominal pain (Clic here for more details about this article) |
4/13. Management of chylous leakage after axillary lymph node dissection in a patient undergoing breast surgery.A 71-year old woman who underwent a modified radical mastectomy for invasive ductal carcinoma of the left breast, developed postoperative chylous leakage. Though conservative management was uneffective, a direct surgical repair led to good results. Because the morbidity of a reoperation to the superficial chest wall is low, timely surgical treatment is therefore strongly recommended in cases of high output chylous leakage following a mastectomy.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/13. Spontaneous chylous peritonitis mimicking acute appendicitis: a case report and review of literature.Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.- - - - - - - - - - ranking = 6.6618055857862keywords = abdominal pain (Clic here for more details about this article) |
6/13. Successful management of late-onset primary lymphatic hypoplasia.Primary lymphedema of the extremities, abdomen, or chest is an unusual and difficult clinical problem with few guidelines for management. A case is reported of lymphedema acquired at the age of 61 years, with associated massive chylous ascites and chylothorax. No underlying condition was discovered and the patient was found to have hypoplastic lymphatics by lymphangiography. Initial management consisted of extremity elevation, diuresis, and repeated paracenteses and thoracenteses. A peritoneojugular shunt provided temporary relief. Surgical pleurodesis combined with intensive diuresis has given prolonged relief of his symptoms allowing him to return to a functional life. Diagnostic and therapeutic guidelines for the management of this unusual condition are suggested.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
7/13. Acute chylous ascites with carcinoid of the pancreas.Acute chylous ascites is of idiopathic origin in 50 per cent of cases, the remainder being accounted for by trauma and intestinal obstruction. It usually presents with acute abdominal pain. Neoplastic disease is much more common in chronic cases, and lymphomas comprise about half of these. Chronic chylous ascites usually presents without pain but with inanition and hypoproteinaemia. This report describes acute chylous ascites following trauma in a patient who was subsequently found to have a pancreatic carcinoid, the lymphangiographic findings being of particular interest.- - - - - - - - - - ranking = 6.6618055857862keywords = abdominal pain (Clic here for more details about this article) |
8/13. Combined occurrence of chyloperitoneum and chylothorax after retroperitoneal surgery.Chyloperitoneum is a rare complication of abdominal or retroperitoneal surgery, and the combined occurrence of chylothorax and chyloperitoneum has been reported in only a few cases. We describe a case of this complication, which became clinically apparent 20 days after a Warren shunt operation. The large chylous effusion compromised breathing and required chest tube drainage, pleurodesis, medium chain triglyceride (MCT) diet, and, later, total parenteral nutrition (TPN). The patient made a full recovery on TPN for 5 weeks.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/13. chylothorax as a complication of radical nephrectomy.We report a case of chylo-retroperitoneum and chylothorax following an uneventful left radical nephrectomy for renal cell carcinoma, and propose the mechanism of an infradiaphragmatic lymphatic injury with fistulous connection into the chest. Treatment with oral medium chain triglycerides was unsuccessful. Subsequently, total parenteral nutrition in conjunction with chest drainage, retroperitoneal drainage and sclerotherapy successfully treated the chylothorax. To our knowledge chylothorax following radical nephrectomy has not been reported previously in the literature.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
10/13. chylothorax: the result of previous radiation therapy?A patient with a remote history of Hodgkin's lymphoma was seen with recurring bilateral pleural effusions, finally diagnosed as chylothorax after many thoracenteses. The patient also had a previous history consistent with chylous ascites. The only plausible etiology of the chylous effusions (and ascites) was previous radiation therapy to the chest and abdomen. This cause of nontraumatic chylothorax is unusual and has been described infrequently in the medical literature.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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