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Abstract：
BACKGROUND: Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks.
METHODS: Case report.
RESULTS: A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.
CONCLUSIONS: A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.
METHODS: Case report.
RESULTS: A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.
CONCLUSIONS: A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.
摘要：
背景：颈部乳糜瘘是罕见的并发症，通常发生于医源性胸导管损伤。没有报道过手术幼稚颈部自发性乳糜渗漏的病例。
方法：病例报告。
结果：一名50岁女性出现进行性左颈部肿胀，但没有发烧，呼吸困难,或者吞咽困难.影像学显示左颈部广泛的浸润性改变，咽后液延伸到绑带肌肉组织和纵隔。柔性喉镜检查显示咽后壁水肿。鉴别诊断包括脓肿和坏死性筋膜炎。开始使用广谱抗生素，并将她带到手术室进行颈部探查。术中,乳状液存在于颈动脉鞘周围和咽后间隙。流体分析显示乳糜微粒和甘油三酯>2400mg/dL。重复颈部成像，胸部，腹部未显示恶性肿瘤或梗阻性肿块。淋巴管图显示颈胸导管附近淋巴管扩张。术后第四天,患者被带回手术室进行胸导管结扎和附近组织活检。病理显示良性淋巴结，窦状扩张。开始低脂饮食，她在医院第9天出院回家。她定期随访，没有复发的迹象。
结论：宫颈乳糜瘘通常由医源性胸导管损伤引起。据我们所知,这是首例自发性宫颈乳糜漏。
方法：病例报告。
结果：一名50岁女性出现进行性左颈部肿胀，但没有发烧，呼吸困难,或者吞咽困难.影像学显示左颈部广泛的浸润性改变，咽后液延伸到绑带肌肉组织和纵隔。柔性喉镜检查显示咽后壁水肿。鉴别诊断包括脓肿和坏死性筋膜炎。开始使用广谱抗生素，并将她带到手术室进行颈部探查。术中,乳状液存在于颈动脉鞘周围和咽后间隙。流体分析显示乳糜微粒和甘油三酯>2400mg/dL。重复颈部成像，胸部，腹部未显示恶性肿瘤或梗阻性肿块。淋巴管图显示颈胸导管附近淋巴管扩张。术后第四天,患者被带回手术室进行胸导管结扎和附近组织活检。病理显示良性淋巴结，窦状扩张。开始低脂饮食，她在医院第9天出院回家。她定期随访，没有复发的迹象。
结论：宫颈乳糜瘘通常由医源性胸导管损伤引起。据我们所知,这是首例自发性宫颈乳糜漏。
