Conservative management of cervicomediastinal chyloma in an infant

Spagnol, Lorna; Zani, Augusto; D’Ambrosio, Giuseppe; Roggini, Mario; D'Ecclesia, G; Cozzi, Denis A.

doi:10.1016/j.jpedsurg.2009.04.006

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Injury to the thoracic duct leading to chyle leak may occur in patients with cervical trauma 3 or those who undergo neck surgery [4][5][6] including neck dissection, thyroidectomy 7 , lymphangioma excision 8 , and vascular surgery 9 .…”

Section: Discussionmentioning

confidence: 99%

Gefitinib Leads to Complete Resolution of Postoperative Cervical Chyloma and Chylothorax in a Lung Cancer Patient

Huang

Chang

Lee

et al. 2014

Tumori

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Cervical chyloma is a not uncommon complication after neck surgery, especially following diagnostic excision of supraclavicular lymph nodes. Conservative treatment remains the standard approach but is inevitably distressful. We describe the case of a 60-year-old Asian woman who was diagnosed as having adenocarcinoma of the lung with cervical and supraclavicular node involvement. She developed persistent cervical chyle leak after excisional biopsy of the supraclavicular nodes and proved refractory to all management. Subsequent gefitinib therapy led to rapid resolution of chyloma and tumor regression. This case provided a unique experience of managing intractable postoperative chyloma in a cancer patient.

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Section: Discussionmentioning

confidence: 99%

Gefitinib Leads to Complete Resolution of Postoperative Cervical Chyloma and Chylothorax in a Lung Cancer Patient

Huang

Chang

Lee

et al. 2014

Tumori

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Surgical Management of Cervical Chyloma Following Parathyroidectomy

et al. 2010

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Chylomas, or chylous lymphoceles, are rare cystic formation of the thoracic duct or its tributaries which arise as an unusual complication following open neck surgery. In the few cases of cervical chyloma reported in the literature, management has varied from watchful waiting to thoracic duct ligation. This report describes the first case of postoperative cervical chyloma following parathyroidectomy and illustrates a successful surgical treatment plan for this infrequent entity.A 56-year-old female underwent a left inferior parathyroidectomy for a parathyroid adenoma at an outside institution. A complex dissection ensued which revealed the adenoma to be located deep to the recurrent laryngeal nerve on the left side. The adenoma was identified and removed and the patient experienced an appropriate drop in her parathyroid hormone level.Postoperatively, the patient developed a cystic central neck swelling. On needle aspiration of the cyst, the fluid was found to be consistent with chyle. Despite numerous attempts at needle decompression in addition to a low-fat diet, the chyle-filled cyst recurred. On presentation to our institution, a 3 x 3-cm cystic mass was noted inferior to the previous suprasternal incision. A noncontrast computed tomography scan of the neck demonstrated a 3.8 x 2.2-cm low density, well-defined midline mass at the level of the mid to inferior thyroid gland consistent with a chyloma ( Figure 1A, B).A surgical excision was performed using continuous nerve monitoring which revealed a well-circumscribed lesion filled with chylous fluid emanating from the previous surgical bed (Figure 2A).The cyst was removed in its entirety after its attachments were meticulously ligated ( Figure 2B). Pathologic examination was consistent with a chylous lymphocele ( Figure 3A,B).Postoperatively, the patient was maintained on a medium-chain triglyceride diet for one week with no evidence of chyloma recurrence both clinically and on repeat radiographic imaging. OBJECTIVES OBJECTIVES : :• To describe the surgical management of a rare case of cervical chyloma following parathyroid adenoma excision. Figure 3A). The cyst contents consisted of brisk lymphocyte infiltration with sheets of organizing fibrin and blood ( Figure 3B). Both of these findings were consistent with a chylous lymphocele. After the surgical excision, there was no further recurrence of the chyloma and the patient continues to do well in followup.We demonstrate that careful re-exploration with definitive ligation and excision of postoperative chylomas is an effective cure for this difficult lesion.

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