Abstract
Eight cases of postoperative chylothorax in children are discussed. The age of the patients varied between 5 hours and 18 months. Chylothorax was diagnosed between 3 and 14 days after operation.
In 6 cases chylothorax was certainly due to damage to the thoracic duct, or other big lymph vessels in the lungs or mediastinum. These patients had no typical pulmonary changes before chylothorax developed.
In 2 cases there was probably no damage to the lymph vessels, but the venous pressure in the upper part of the body was elevated by constriction of the superior caval vein. The anatomical prerquuisites for chylothorax in these cases is discussed. In these patients, before chylothorax, pulmonary changes appeared in the radiograph interpreted as widened lymph vessels and caused al altered lymph flow at the periphery. If pulmonary changes of this kind appear in patients with elevation of pressure in the superior caval vein, this may be a sign that chylothorax may develop.
The importance of early diagnosis is stressed. Drainage of the pleura with continuous suction has proved to be the therapy of choice. Direct operation has not been necessary in any of our cases.
Similar content being viewed by others
References
Althaus, U., Fuchs, W.: Chylothorax nach kardiovaskulären Eingriffeen. Schweiz. med. Wschr.102, 44 (1972)
Blalock, A., Cunningham, R., Robinson, C.: Experimental production of chylothorax by occlusion of the superior vena cava. Ann. Surg.104, 359 (1936)
Bower, G.: Chylothorax. Dis. Chest.46, 464 (1964)
Chavez, C. M., Conn, J. H.: Thoracic duct laceration J. Thorac. Cardiovasc. Surg.51, 724 (1966)
Decanq, H. G.: The treatment of chylothorax in children. Surg. Gynec. Obstet.121, 509 (1965)
Glenn, W. W. L., Ordevay, N. K., Talner, N. S., Call, E. P.: Shunt between superior vena cava and distal right pulmonary artery. Report of clinical application in 38 cases. Circulation31, 172 (1965)
Higgins, C. B., Mulder, D. G.: Chylothorax after surgery for congenital heart disease. J. Thorac. Cardiovasc, Surg.61, 411 (1971)
Kuntz, E.: Der Chylothorax. Beitr. Klin. Tuberk.133, 98 (1966)
Lampson, S.: Traumatic chylothorax. J. Thorac. Surg.17, 778 (1948)
Lawrance, K.: Idiopathic chylothorax. Brit. J. Surg.48, 653 (1961)
Louhimo, I., Kekomäki, M., Pasila, M., Sulamaa, M.: Chylothorax and chylopericardium as a problem in pediatric surgery. Z. Kinderchir. Suppl. 1966, p. 18
Maloney, J. V., Jr., Spencer, F. C.: The nonoperative treatment of traumatic chylothorax. Surgery40, 121 (1956)
McKendry, J. B. J., Lindsay, W. K., Gerstein, M. C.: Congenital defects of the lymphatics in infancy. Pediatrics19, 21 (1957)
Ross, K.: A review of the surgery of the thoracic ducr. Thorax16, 12 (1961)
Schwartz, H.: Herzchirurgie beim Säugling und Kleinkind, p. 78, Berlin, Heidelberg, New York: 1968
Steiger, Z., Weinberg, M., Fell, E. H.: Postoperative chylothorax. Amer. J. Surg.100, 8 (1960)
Trapnell, D. H.: The peripheral lymphatics of the lung. Brit. J. Radiol.36, 660 (1963)
Weidner, W. A., Steiner, R. M.: Roentgenographic demonstration of intrapulmonary and pleural lymphatics during lymphangiography. Radiology100, 533 (1971)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Holm, AL., Söderlund, S. Experiences of postoperative chylothorax in children. Pediatr Radiol 4, 10–13 (1975). https://doi.org/10.1007/BF00978813
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00978813