| A clinical observation on chylothorax in childhood. |
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Mi Jin Jung, Joon Jai Kim, Young Ah Lee, Chung Il Noh, Jung Hwan Choi, Chong Ku Yun |
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Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea |
| 소아 유미흉의 임상적 고찰 |
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정미진, 김준재, 이영아, 노정일, 최중환, 윤종구 |
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서울대학교 의과대학 소아과학교실 |
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Received: 28 September 1990 • Accepted: 29 November 1990 |
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| Abstract |
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Fourteen patients who had developed a chylothorax in childhood during a ten year period, from
Jan. 1979 to July 1989, were reviewed by their hospital records. The chylothoraces occurred most
frequently as complications of cardiothoracic surgeries in eight patients(57%). Four cases followed
extrapericardial operations such as ligation of PDA and take-down of Blalock-Taussig shunt, and
four cases followed intrapericardial operations such as corrective operations of Fallofs tetralogy and
Fontan operation. The latent period was 5 to 44 days (mean 13.3 days) and five cases had bilateral
sided effusions(63%). Others were three cases of congenital chylothorax and one case associated
multiple lymphangiomatosis of bone, and one case associated complete obstruction of left internal
jugular vein due to thrombosis which developed after Fontan operation. Two cases of congenital
chylothorax had had difficult delivery history and left sided chylothorax. Not all cases showed
milkish appearance on initial thoracentesis, especially on NPO state, but the cellular component was
primarily lymphocytic (64—100%). All cases were treated initially with chest tube drains and diet
theraphy-MCT oil and fat free diet or skim milk-or parenteral nutrition on NPO state.
Twelve cases (86%) were improved during 6 to 40 days of chest drains. Two cases received
pleurodesis, of whom one received operations of removal of leaking lymphatic sac with improvement
of chylothorax. Empyema and malnutrition were complicated after long standing drains. In our
review, chylothoraces followed frequently intrapericardial surgery in comparison with other reports.
The conservative management had a good result in most of chylothoraces of variable causes.
Congenital chylothoraces were well controlled by conservative management and had a good
prognosis. After Fontan operation anticoagulant therapy would be used for the prevention of throm-
bosis. Ifs thought that a further study of nutritional method and appropriate time for the operative
management should be made. |
| Key Words:
Chylothorax, Childhood |
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