Schwannomas, originating from the Schwann sheath of peripheral or cranial nerves, are rare tumors commonly found in the head and neck or extremities. Adrenal schwannomas, however, are exceedingly rare, accounting for less than 1% of all adrenal tumors. Here, we present a case of a 31-year-old Caucasian woman diagnosed with an adrenal schwannoma, which was incidentally discovered during imaging studies for an unrelated issue. Following laparoscopic adrenalectomy, the patient developed chylous ascites (CA) and coexistent chylothorax, posing a diagnostic challenge and necessitating a multidisciplinary approach to management.

Background Postoperative chylothorax is a rare but life-threatening complication of esophagectomy. However, due to its rarity, researching the risk factors and selecting appropriate treatment options has been limited. Methods This study included 727 patients with esophageal cancer who underwent minimally invasive esophagectomy at our hospital. To detect the risk factors for chylothorax, we divided the patients into two groups, with and without postoperative chylothorax. We then compared patient characteristics, tumor-specific variables, and operative details. Subsequently, we analyzed the peri-treatment characteristics and outcomes for the three distinct treatment options we had chosen: surgery, conversion (the group that finally underwent surgery after unsuccessful conservative treatment), and conservative. Results Of the 727 patients, 18 (2.5%) developed a chylothorax. The mean BMI was lower (20.3 vs. 21.9, p=0.057), and more cases of thoracic duct resection were found in the chylothorax group (33.3% vs. 6.2%, p=0.001), with statistical significance. Multivariate analysis identified thoracic duct resection as a risk factor (adjusted odds ratio, 6.83). The drainage volume two days after chylothorax was higher in the surgery group, although the difference was not statistically significant (surgery group, 1,405 ml vs. conversion group, 260 ml vs. conservative group, 310 ml; p=0.073). The surgery group had the shortest median postoperative hospital days among these groups (21.5 as compared to 102 and 25.0 days in the conversion and conservative groups, respectively; p<0.001). None of the patients died during their hospital stays. Conclusion Thoracic duct resection during the initial minimally invasive esophagectomy was an independent risk factor for chylothorax. If drainage volume does not decrease on the second day, early surgery may lead to earlier discharge.

UNASSIGNED: Early removal of chest tubes reduces pain and morbidity. This study aimed to remove chest tubes immediately after robotic pulmonary resection with complete thoracic lymphadenectomy by administering ice cream to rule out chylothorax.
UNASSIGNED: This quality improvement study utilized prospectively gathered data from one thoracic surgeon. Patients were given 3.6 fl oz of ice cream in the recovery room within 1 h after their operation. Chest tubes were removed within 4 h if there was no chylous drainage and air leak on the digital drainage system.
UNASSIGNED: From January 2022 to August 2023, 343 patients underwent robotic pulmonary resection with complete thoracic lymphadenectomy. The median time to ingest the ice cream was 1.5 h after skin closure. The incidence of chylothorax was 0.87% (3/343). Two patients were diagnosed with chylothorax after consuming ice cream within 4 h of surgery. One patient, whose chest tube remained in place due to an air leak, had a chylothorax diagnosed on postoperative day 1 (POD1). All three patients were discharged home on POD1 with their chest tubes in place, adhering to a no-fat, medium-chain triglyceride diet. All chylothoraces resolved within 6 days. None of the remaining patients developed chylothorax postoperatively with a minimum follow-up period of 90 days.
UNASSIGNED: Providing ice cream to patients after pulmonary resection and complete thoracic lymphadenectomy is an effective and reliable technique to rule out chylothorax early in the postoperative period and facilitates early chest tube removal. Further studies are needed to ensure that this simple, inexpensive test is reproducible.

Chylothorax is the accumulation of lymphatic fluid (chyle) within the pleural space. There are multiple causes, including traumatic and non-traumatic mechanisms. Trauma can cause disruption of the thoracic duct either by direct damage or indirect crushing or avulsion mechanisms. Non-traumatic causes include infections, inflammatory processes, malignancies, and iatrogenic injury (during surgery or central venous access). The traditional management of traumatic chylothorax has been either a conservative approach, including complete Nil Per Os (NPO), or a low-fat diet with medium-chain triglyceride supplementation with the administration of somatostatin or its analog, octreotide, versus a surgical approach consisting of thoracic duct ligation. Recently a less invasive approach via thoracic duct embolization has gained popularity. There have been a few reports of the successful use of an α 1-adrenergic agonist (midodrine) as an adjunct in the conservative approach. We describe the utility of midodrine in three cases of chylothorax and propose a management algorithm.
CONCLUSIONS: The initial diagnosis of chylothorax is based on clinical suspicion and proper imaging.The clinical success of midodrine use as a first-line medical treatment for chylothorax will support the use of midodrine before considering invasive procedures.We propose a management algorithm for patients with chylothorax that will stimulate researchers to conduct prospective studies to assess its efficacy.

This is the first case report of a very low-carbohydrate, high-fat ketogenic diet for the treatment of chylothorax. A 61-year-old female with recurrent chylothorax following thoracic surgery was refractory to a very low-fat diet managed by a hospital dietitian. She required repeated palliative thoracentesis to the point where she was scheduled for a thoracic duct embolization. Prior to the embolization, she was placed on a very low-carbohydrate (<20 total grams daily), high-fat, ketogenic diet. Metabolic markers and imaging were obtained regularly. The patient had improvements in her serum triglycerides, triglyceride/HDL ratio, and triglyceride-glucose index, as well as clinical and radiographic improvements in her chylothorax as assessed by a chest X-ray and CT scan. Within three months of starting her ketogenic diet, imaging revealed complete resolution of the chylous pleural effusion. This case suggests that metabolic optimization to decrease insulin resistance, improve chylomicron metabolism, decrease lymphatic permeability, and lower serum triglycerides, as occurs with a ketogenic diet, should be considered for conservative treatment of chylothorax and warrants further study.

A chylothorax, the accumulation of lymphatic fluid in the pleural space, may occur for a variety of reasons. It is commonly seen in adults post-thoracic surgery. We present the case of a seven-month-old girl with a right-sided chylothorax in the setting of non-accidental trauma. Treatment options for a chylothorax include surgical ligation of the thoracic duct or, as in this case, a minimally invasive procedure performed by interventional radiology known as lymphangiography with thoracic duct embolization. This case highlights interventional radiologists\' ability to treat complex lymphatic pathologies effectively with minimally invasive techniques.

BACKGROUND: Chylous fluid leakage following spinal surgery is a rare and potentially difficult-to-manage complication that can lead to wound complications, pain, or nutritional deficiencies. Although the thoracic duct is localized near the thoracic spine, reports of thoracic duct injuries secondary to posterior thoracic spine surgery are rare.
METHODS: The authors present the case of a 57-year-old male with a known history of metastatic renal cell carcinoma to the thoracic spine who had undergone a thoracolumbar fusion with thoracic corpectomy and presented with concern for a chyle leak almost a year after his surgery. The patient had a complicated oncological history and underwent decompression and fusion to treat his significant thoracic metastatic disease. A year later, he presented with back pain and a significant fluid collection at the surgical site, which was drained and found to be consistent with chyle. The patient was treated conservatively, and imaging of the thoracic duct a few months later demonstrated no direct injury, likely indicating either transient injury or potential obstruction of the thoracic duct from metastatic disease.
CONCLUSIONS: This case demonstrates a rare, potential complication when treating extensive thoracic metastatic disease as well as the workup and potential treatments when facing thoracic duct injury. https://thejns.org/doi/10.3171/CASE24280.

We report here a rare case of neuroblastoma in a neonate who presented as a hydropic baby with respiratory distress due to recurrent chylothorax. The neuroblastoma regressed after six cycles of chemotherapy and the infant was discharged in good condition.

Chylothorax is a severe complication following the Fontan procedure, causing significant morbidity and mortality due to nutritional depletion and fluid loss. We present a case involving a six-year-old girl with tricuspid atresia, atrial septal defect (ASD), ventricular septal defect (VSD), and severe pulmonary stenosis (PS), presenting with fever, non-productive cough, and increased work of breathing. Cyanosis was noted, improving with oxygen. Imaging revealed bilateral pleural effusion, with pleural fluid analysis confirming chylothorax. Despite normal laboratory reports, retrograde transvenous lymphangiography indicated thoracic duct leakage. The patient underwent successful thoracic duct embolization, resulting in the resolution of the effusion and stabilization of her condition. She was discharged in a stable state, with follow-up care.

This report aims to investigate the association between 47,XXX and fetal hydrops by examining a clinical case and performing a comprehensive review of the relevant literature. A 34-year-old Japanese woman, gravida 2, para 1, was diagnosed with fetal hydrops at 27 weeks\' gestation. Prenatal testing revealed a 47,XXX karyotype. Interventions included thoracocentesis and a thoracoamniotic shunt. A cesarean delivery was performed at 34 weeks and the female neonate initially had respiratory challenges. After 69 days in the neonatal intensive care unit, the infant was discharged in stable condition, and the 47,XXX karyotype was confirmed. This case may add evidence suggesting an association between 47,XXX and fetal hydrops. Chromosomal abnormalities are causes of fetal hydrops, but its association with 47,XXX remains unclear. Providing comprehensive information on this condition to couples is crucial, and considering the inclusion of fetal hydrops in the list of associated conditions might be advisable.