Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory. Port Manteaux churns out silly new words when you feed it an idea or two. Enter a word (or two) above and you'll get back a bunch of portmanteaux created by jamming. Malignant pleural effusion complicates the care of approximately 150,000 people in the United States each year. This can occur de novo as a result of trauma or obstruction of the. Editorial Office of Gastroenterology and Hepatology Research. ACT Publishing Group Limited. Pleural Disease Online Medical Reference - covering Definition through Treatment. Authored by Raed A. Dweik of the Cleveland Clinic. Pleural effusion is usually the. ![]() SURGICAL OPERATIONS: surgery is the branch of medicine that treats diseases, injuries, and deformities by manual or operative methods (click here for main in. The American Journal of Gastroenterology (2008) 103, S206–S372; doi:10.1111/j.1572-0241.2008.02139. Clinical Vignettes. Management of chylothorax. INTRODUCTIONChylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in leakage of chyle (lymphatic fluid of intestinal origin) into the pleural space. Chylous ascites can also flow into the pleural space. The fluid typically has a high triglyceride content and often a turbid or milky white appearance. In contrast, a cholesterol pleural effusion, which can also have a milky appearance, has a high concentration of cholesterol and lecithin- globulin complexes that accumulate due to pleural inflammation or infection. A pleural fluid triglyceride concentration greater than 1. ![]() L (1. 2. 4 mmol/L) strongly supports the diagnosis of a chylothorax, but triglyceride concentrations may be less than 1. L in 1. 5 percent of patients and less than 5. L in 3 percent . If the triglyceride level is less than 1. L (less than 1. 2. L) but the diagnosis is suspected clinically, the presence of chylomicrons in the pleural fluid by lipoprotein analysis can confirm the presence of a chylothorax. The therapeutic options and an approach to managing chylothorax will be reviewed here. The etiology, clinical presentation, and diagnosis of chylothorax, the evaluation and management of cholesterol effusions, and general issues regarding the evaluation and treatment of pleural effusions are discussed separately. More rarely- used modalities include somatostatin/octreotide, midodrine, sirolimus, pleurovenous or pleuroperitoneal shunting, therapeutic lymphangiography, and thoracic duct embolization or disruption. Staged approaches for using the various options based on the etiology of the chylothorax are discussed in the following sections. ![]() Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in leakage of chyle (lymphatic fluid of intestinal origin. Management of Chylothorax Thoracic Duct Anatomy Above clavicle, duct turns laterally. It turns inferiorly to enter the venous system at the. Approach Considerations, Therapeutic Thoracentesis, Tube Thoracostomy. Diaz- Guzman E, Dweik RA. Diagnosis and management of pleural effusions: a practical approach. Winter. 3. 3(4): 2. Normal volume and cellular contents of pleural fluid. Curr Opin Pulm Med. The differential diagnosis of pleural effusions. Pleural effusions of extravascular origin. Clin Chest Med. 2. The undiagnosed pleural effusion. Clin Chest Med. 2. Culotta R, Taylor D. Diseases of the pleura. Ali J, Summer WR, Levitzky MG, eds. Pulmonary Pathophysiology. 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Blood culture bottle culture of pleural fluid in pleural infection. Abouzgheib W, Bartter T, Dagher H, Pratter M, Klump W. A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion. Swiderek J, Morcos S, Donthireddy V, et al. Prospective study to determine the volume of pleural fluid required to diagnose malignancy. Sakuraba M, Masuda K, Hebisawa A, Sagara Y, Komatsu H. Pleural effusion adenosine deaminase (ADA) level and occult tuberculous pleurisy. Ann Thorac Cardiovasc Surg. Gurung P, Goldblatt M, Huggins JT, et al. Pleural Fluid Analysis, Radiographic, Sonographic and Echocardiographic Characteristics of Hepatic Hydrothorax. Jan 2. 7. Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound. Mar- Apr. 4. 0(3): 1. Mercaldi CJ, Lanes SF. 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