PDF(Pubmed)
Abstract：
UNASSIGNED: Chylothorax is the leakage of chyle into the pleural space and is associated with up to 50% morbidity. Although, the identification of traumatic chylothoraces is well described, non-traumatic chylothoraxes, mostly idiopathic, present therapeutic challenges as they are difficult to localize. We describe an attempt at localizing and treating an idiopathic chylothorax refractory to conservative and minimally invasive techniques. This was done using indocyanine green (ICG) and was a joint case between a thoracic surgeon and an interventional radiologist.
UNASSIGNED: A 50-year-old female with a recent history of coronavirus disease (COVID)-19 presented with shortness of breath. She was found to have a right pleural effusion and was admitted to the hospital, where a chest tube was inserted and pleural fluid analysis confirmed the diagnosis of a chylothorax. Conservative management was attempted but with little success. Initial magnetic resonance lymphangiogram (MRL) revealed abnormal enhancing lymphatic masses in the right paraspinal thoracic space as well as lympho-venous junction obstruction with large neck collaterals. She then underwent percutaneous lympho-venous junction angioplasty followed by multiple rounds of glue embolization without clinical improvement. The decision was then made to proceed with a thoracotomy, identification of the site of thoracic duct (TD) leakage, and a mechanical pleurodesis assisted by intraoperative imaging. Ten mg of ICG was injected into the inguinal lymph nodes. Using a camera capable of detection of near-infrared (NIR) light, we were able to visualize the site from which the ICG was extravasating in the chest. Glue was then injected in that area to further help in reducing the leak. After keeping her nil per os (NPO) and requiring one more ligation, a repeat MRL showed a markedly decreased leak into the right pleural space. Two weeks later, she was seen in clinic and reported significant improvement in her symptoms.
UNASSIGNED: This is the case of a 50-year-old female who was found to have a significant right chylothorax. She underwent conservative management, followed by tube thoracostomy, and TD ligation but was refractory to treatment. Fluorescence-guided surgery was pivotal to localize the leakage site and help seal it intraoperatively.
UNASSIGNED: A 50-year-old female with a recent history of coronavirus disease (COVID)-19 presented with shortness of breath. She was found to have a right pleural effusion and was admitted to the hospital, where a chest tube was inserted and pleural fluid analysis confirmed the diagnosis of a chylothorax. Conservative management was attempted but with little success. Initial magnetic resonance lymphangiogram (MRL) revealed abnormal enhancing lymphatic masses in the right paraspinal thoracic space as well as lympho-venous junction obstruction with large neck collaterals. She then underwent percutaneous lympho-venous junction angioplasty followed by multiple rounds of glue embolization without clinical improvement. The decision was then made to proceed with a thoracotomy, identification of the site of thoracic duct (TD) leakage, and a mechanical pleurodesis assisted by intraoperative imaging. Ten mg of ICG was injected into the inguinal lymph nodes. Using a camera capable of detection of near-infrared (NIR) light, we were able to visualize the site from which the ICG was extravasating in the chest. Glue was then injected in that area to further help in reducing the leak. After keeping her nil per os (NPO) and requiring one more ligation, a repeat MRL showed a markedly decreased leak into the right pleural space. Two weeks later, she was seen in clinic and reported significant improvement in her symptoms.
UNASSIGNED: This is the case of a 50-year-old female who was found to have a significant right chylothorax. She underwent conservative management, followed by tube thoracostomy, and TD ligation but was refractory to treatment. Fluorescence-guided surgery was pivotal to localize the leakage site and help seal it intraoperatively.
摘要：
■乳糜胸是乳糜漏入胸膜腔，发病率高达50％。虽然,对创伤性乳糜胸的鉴定有很好的描述，非创伤性乳糜胸,主要是特发性的,目前的治疗挑战，因为他们是难以本地化。我们描述了一种对保守和微创技术难以治疗的特发性乳糜胸进行定位和治疗的尝试。这是使用吲哚菁绿（ICG）完成的，是胸外科医师和介入放射科医师之间的联合病例。
一名50岁女性，近期有冠状病毒病(COVID)-19病史，表现为呼吸急促。她被发现右侧胸腔积液,住进医院,插入胸管，胸膜液分析证实乳糜胸的诊断。尝试了保守的管理，但收效甚微。最初的磁共振淋巴管图（MRL）显示右侧椎旁胸腔的淋巴肿块异常增强，以及颈部大侧支的淋巴静脉交界处阻塞。然后，她接受了经皮淋巴静脉交界处血管成形术，然后进行了多轮胶水栓塞，但临床上没有改善。然后决定进行开胸手术，确定胸导管（TD）渗漏的部位，术中影像学辅助的机械胸膜固定术。将10mg的ICG注射到腹股沟淋巴结中。使用能够检测近红外（NIR）光的相机，我们能够看到ICG在胸部溢出的部位。然后在该区域注入胶水以进一步帮助减少泄漏。在保持无操作系统(NPO)并需要再结扎一次之后，重复MRL显示右胸膜腔渗漏明显减少.两周后,她在诊所就诊,并报告症状明显改善.
■这是一名50岁的女性，被发现患有明显的右乳糜胸。她接受了保守的管理，接着是管状胸廓造口术,和TD结扎，但难以治疗。荧光引导手术对于定位渗漏部位并在术中帮助密封渗漏部位至关重要。
一名50岁女性，近期有冠状病毒病(COVID)-19病史，表现为呼吸急促。她被发现右侧胸腔积液,住进医院,插入胸管，胸膜液分析证实乳糜胸的诊断。尝试了保守的管理，但收效甚微。最初的磁共振淋巴管图（MRL）显示右侧椎旁胸腔的淋巴肿块异常增强，以及颈部大侧支的淋巴静脉交界处阻塞。然后，她接受了经皮淋巴静脉交界处血管成形术，然后进行了多轮胶水栓塞，但临床上没有改善。然后决定进行开胸手术，确定胸导管（TD）渗漏的部位，术中影像学辅助的机械胸膜固定术。将10mg的ICG注射到腹股沟淋巴结中。使用能够检测近红外（NIR）光的相机，我们能够看到ICG在胸部溢出的部位。然后在该区域注入胶水以进一步帮助减少泄漏。在保持无操作系统(NPO)并需要再结扎一次之后，重复MRL显示右胸膜腔渗漏明显减少.两周后,她在诊所就诊,并报告症状明显改善.
■这是一名50岁的女性，被发现患有明显的右乳糜胸。她接受了保守的管理，接着是管状胸廓造口术,和TD结扎，但难以治疗。荧光引导手术对于定位渗漏部位并在术中帮助密封渗漏部位至关重要。
