Chylothorax as A Complication After Delivery

Abstract

A 23-year old female who developed a chylothorax as a probable complication after delivery is described and a possible mechanism is proposed. Conservative treatment was unsuccessful and the surgical management was complicated by an anatomical variation with the thoracic duct presenting as a plexiform system instead of a single duct.

Lymphoscintigraphy using technetium-99m HSA-DTPA with SPECT/CT in chylothorax after childbirth

“…10,11 With the obstructed expiratory effort of the Valsalva maneuver, high intrathoracic pressure is transmitted to thoracic structures, causing duct rupture after coughing, straining, and/or vomiting. Without malignant or infectious disruption of the duct, it has been postulated that congenital malformation or inherent weakness may be present in these rare individuals.…”

Chylothorax after childbirth in a mother

“…In the thoracic part of the duct, high stretching forces thus occur on the ductal wall due to high intraluminal and low extraluminal pressure.' [4] In two previous reports, chylothorax was found after prolonged vaginal delivery where extensive external pressure was applied to the abdomen. [4,5] However, in our patient, no external pressure was applied to the abdomen.…”

“…Tornling et al [4] reported the first case of chylothorax after delivery and described its mechanism as follows: 'During labor throes, there is initially an increased intrathoracic and intra-abdominal pressure followed by a rapid decrease to negative intrathoracic pressure with persistent high intra-abdominal pressure. In the thoracic part of the duct, high stretching forces thus occur on the ductal wall due to high intraluminal and low extraluminal pressure.'…”

“…[3] When practiced at high frequencies (i.e., approximately 120 breaths per min), autonomic changes, based on the heart rate variability spectrum, suggested increased sympathetic and reduced vagal activity. [4] However, despite the supposed effect on the…”

“…[4,5] A 32-year-old woman presented with dyspnea 11 days after normal vaginal delivery. She had no history of recent obvious trauma or constitutional complaints.…”