Chylothorax caused by blunt chest trauma: a review of literature
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REVIEW ARTICLE
Chylothorax caused by blunt chest trauma: a review of literature Fahmi Hussein Kakamad 1,2 & Rawezh Qadir M. Salih 2,3 & Shvan Hussein Mohammed 2 & Ahmed Ghafour HamaSaeed 4 & Dlawar Ali Mohammed 5 & Vanya Ibrahim Jwamer 6 & Pshtiwan Gharib Ali 5 & Tomas M.Sharif M.Mikael 2,7 & Marwan Nasih Hassan 6 & Rebwar Ahmed Ali 2 & Abdulwahid Mohammed Salih 8 Received: 19 July 2019 / Revised: 25 October 2019 / Accepted: 7 November 2019 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Chylothorax is the accumulation of chyle in the pleural cavity that typically contains a high concentration of triglycerides. Blunt chest trauma is a rare cause. The aim of this study is to review all of the reported cases of chylothorax caused by blunt chest trauma. Available databases were explored systematically for the condition and the eligible papers were included. The literature search revealed 30 studies with 39 cases, 72.3% of the cases were male, and 21.7% of the patients were female. The age range varied between 4 and 75 years with a mean age of 35.8 years. All of the patients were diagnosed after fluid sampling from the pleural fluid by thoracentesis and/or chest tube insertion. About 71.4% of the patients were treated successfully by conservative management: others (28.6%) were managed surgically. Although it is a rare condition, persistent milky drainage after blunt chest trauma should raise the suspicion of chylothorax. Pleural fluid sampling is the cornerstone of the diagnosis. In the majority of the cases, conservative treatment is quite enough. Surgery is indicated whenever non-operative measures failed. Keywords Conservative management . Thoracic duct . Injury . Trauma . Operation
Introduction Chylothorax is the accumulation of chyle in the pleural cavity that typically contains a high concentration of triglycerides (> 110 mg/dL [> 1.24 mmol/L]). Generally, it occurs because of a leak from the main trunk or the tributaries of the thoracic duct [1]. Longelot was accredited with the first description of chylothorax in German literature while in the setting of the trauma, the first case was outlined by Quincke [2]. If left untreated, it is a fatal disease, causing death in 30–50% of the cases from malnutrition, immunodeficiency, or heart
* Fahmi Hussein Kakamad [email protected] 1
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failure [1]. The condition can be categorized as congenital and acquired; the latter could be spontaneous, traumatic iatrogenic, or traumatic non-iatrogenic [3]. Iatrogenic cases are accounted for the majority of conditions, predominantly, during operation for the esophageal diseases (0.4% to 2%) [4]. Penetrating chest trauma in the form of gunshot or stab wounds is the second most prevalent cause of chylothorax [5]. The precise etiology of the disease is not well recognized in nearly 15% of the cases [6]. Chylothorax caused by blunt chest trauma is a rare entity. The etiology is thought to be due to an abrupt hyperextension of the vertebral column leading to
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