Chylothorax

Introduction Different causes of the chylothorax lead to rupture or obstruction of the thoracic duct, causing the chyle to overflow into the chest. The thoracic duct is the largest lymphatic vessel in the body, with a total length of about 30~40cm. It is divided into two parts, one is the primary disease manifestation; the other is the symptoms of the chylothorax itself. Traumatic thoracic duct rupture, chyle overflows quickly, can produce compression symptoms, such as shortness of breath, difficulty breathing, mediastinal shift. Disease Description: The chylothorax causes different causes of rupture or obstruction of the thoracic duct, causing the chyle to overflow into the chest. The thoracic duct is the largest lymphatic vessel in the body, with a total length of about 30~40cm. It originates from the chyle pool in front of the first lumbar vertebrae in the abdominal cavity and passes through the transverse aorta through the aortic sulcus into the mediastinum. Then along the right front of the vertebral body and the posterior esophagus, the vertebral body is obliquely left to the left at the fifth thoracic vertebra. In the vertebral body and esophagus to the left side of the neck, through the carotid sheath behind the subclavian artery back and the left venous angle (the left jugular vein and the left subclavian vein confluence). The thoracic duct drains the lymph fluid below and to the left side of the palate. According to the study, 60% to 70% of the body's fat intake is collected by the lymphatic vessels of mucosal villi and remitted into the chyle pool. The intestinal lymph is milky white due to the presence of triglycerides and chylomicrons, which are injected into the body through the thoracic duct. The flow and traits of the thoracic duct chyle vary with the diet. Usually about 60~100ml per hour, the total daily amount is about 1.5~2.5L. When eating fatty foods, the flow rate increases and is milky, and the amount is small and bright when hungry or fasting.

Cause

an examination

Related inspection

Thoracic surgery

Laboratory inspection:

1. The appearance of pleural effusion 0.50 is milky, 0.12 is serous or serous. After placement, there is an oily film on the upper layer, which is still cloudy after centrifugation.

2. Pleural effusion examination of pleural fluid triglyceride is often > 2.75mmol / L, and higher than plasma, cholesterol / triglyceride <1.

Other auxiliary inspections:

X-ray examination: the flat film is more than a medium amount, a large amount of fluid image. The lung, mediastinum, pleural primary and metastatic tumors can be observed by CT. Lymphangiography can be used to identify the location of the thoracic duct and the location of its breach.

Differential diagnosis

Diagnosis of chylothorax:

General diagnosis has no special difficulties, such as chest drainage fluid or thoracic puncture fluid is milky white turbid liquid, and the amount is considerable, up to 500 ~ 1000ml per day, the daily chest drainage volume has not decreased, the possibility of chylothorax should be considered. In order to identify the nature of the pleural fluid, pleural fluid can be sent for chyle test or pleural smear microscopy and bacterial culture. Generally, the chyle is usually divided into two layers after being placed, the upper layer is a fat layer, and the lower layer is a liquid. The pleural effusion was stained with SudanIII to visualize the fat granules.

Clinical manifestations:

1. Chest tightness, shortness of breath, especially when the amount of activity is large or when eating more fatty foods.

2. There is no positive sign in a small amount of chylothorax effusion; when the amount is too much, the respiratory movement of the affected side is weakened, the voiced sound is percussed, and the breath sound is weakened or disappeared.

Diagnosis basis :

1. Chest tightness, shortness of breath.

2. There are signs of pleural effusion, chest radiographs suggest pleural effusion.

3. Chest puncture can extract milky white liquid, and the chyle is qualitatively positive.

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