High-volume bilateral chylothorax presenting with hypoxemia and shock in a pediatric patient following tracheostomy revision: a case report.

Abstract

INTRODUCTION:

Chylothorax is a rare complication of surgical neck dissection. This is the first reported pediatric case of bilateral chylothorax following cervical surgery and the first to occur after tracheoplasty. Chylothorax can lead to significant complications, including hypoxemia and shock, and requires timely treatment. This case report discusses the clinical presentation, diagnosis, and treatment of our patient and reviews possible pathophysiologic mechanisms to explain the development of postoperative bilateral chylous effusions.

CASE PRESENTATION:

An 18-month-old white baby girl with a complex past medical history including choanal atresia, atrioventricular septal defect, failure to thrive, developmental delay, and tracheostomy dependence developed significant hypoxemia and shock following a routine tracehostomy revision. She was subsequently found to have developed massive bilateral chylothorax, requiring escalation of mechanical ventilation, thoracostomy tube drainage, vasoactive support, and eventual surgical ligation of her thoracic duct.

CONCLUSIONS:

Massive bilateral chylothorax is a rare but potentially life-threatening complication following tracheoplasty. Clinicians caring for this patient population postoperatively should be aware of this potential complication and its management.

• Authors: Aaron L Thatcher, Jane Yu, Kevin W Kuo
• Journal: Journal of medical case reports (J Med Case Rep) Vol. 9 Pg. 235 (Oct 22 2015) ISSN: 1752-1947 [Electronic] England
• PMID: 26493840 (Publication Type: Case Reports, Journal Article)

Topics

• Chylothorax (diagnosis, therapy)
• Drainage
• Female
• Heart Failure (surgery)
• Humans
• Hypoxia (etiology)
• Infant
• Neck Dissection (adverse effects)
• Postoperative Complications (diagnosis)
• Reoperation
• Shock (etiology)
• Thoracic Duct (surgery)
• Tracheobronchomalacia (surgery)
• Tracheostomy