Abstract
Chylothorax is a rare complication of neck dissection. We report three cases of chylothorax after neck dissections for thyroid carcinoma and attribute this relatively high incidence to the assumption that most patients are asymptomatic. Thus, conventional chest X-ray or ultrasonography in the early postoperative period may be warranted to exclude asymptomatic chylothorax, especially if the thoracic duct is injured and ligated during the operation. We suggest that for chylothorax induced by ligation of the thoracic duct, which may be transient and resolve quickly, short-term thoracic drainage is enough.
Similar content being viewed by others
References
Vaiman M, Nagibin A, Olevson J. Complications in primary and completed thyroidectomy. Surg Today. 2010;40(2):114–8.
Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Ann Thorac Surg. 2001;71(2):448–50.
Stuart WJ. Operative injury of the thoracic duct in the neck. Edinb Med J. 1907;22:301–6.
Frazell EL, Harrold CC, Rasmussen L. Bilateral chylothorax: an unusual complication of radical neck dissection with recovery. Ann Surg. 1951;134(1):135–7.
Coates HL, DeSanto LW. Bilateral chylothorax as a complication of radical neck dissection. J Laryngol Otol. 1976;90(10):967–70.
Saraceno CA, Farrior RT. Bilateral chylothorax. Rare complication of neck dissection. Arch Otolaryngol. 1981;107(8):497–9.
Har-El G, Segal K, Sidi J. Bilateral chylothorax complicating radical neck dissection: report of a case with no concurrent external chylous leakage. Head Neck Surg. 1985;7(3):225–30.
Ng RS, Kerbavaz RJ, Hilsinger RL Jr. Bilateral chylothorax from radical neck dissection. Otolaryngol Head Neck Surg. 1985;93(6):814–7.
Pace-Balzan A, Moriarty B. Bilateral chylothorax following left radical neck dissection (case report). J Laryngol Otol. 1988;102(3):288–90.
Oi K, Haraguchi N, Machida S, Beppu T, Ogawa A, Yeh YF, et al. Dyspnea resulting from accumulation of pleural effusion after radical neck dissection. A case report. Oral Surg Oral Med Oral Pathol. 1989;67(3):258–61.
Biurrun O, Sabater F, Traserra J. Bilateral chylothorax after radical neck dissection. Apropos of a case. Rev Laryngol Otol Rhinol (Bord). 1992;113(2):111–3.
PJabbar AS, Al-Abdulkareem A. Bilateral chylothorax following neck dissection. Head Neck. 1995;17(1):69–72.
Postma GN, Keyser JS. Management of persistent chylothorax. Otolaryngol Head Neck Surg. 1997;116(2):268–70.
Gregor RT. Management of chyle fistulization in association with neck dissection. Otolaryngol Head Neck Surg. 2000;122(3):434–9.
Al-Sebeih K, Sadeghi N, Al-Dhahri S. Bilateral chylothorax following neck dissection: a new method of treatment. Ann Otol Rhinol Laryngol. 2001;110(4):381–4.
Jortay A, Bisschop P. Bilateral chylothorax after left radical neck dissection. Acta Otorhinolaryngol Belg. 2001;55(4):285–9.
Kamasaki N, Ikeda H, Wang ZL, Narimatsu Y, Inokuchi T. Bilateral chylothorax following radical neck dissection. Int J Oral Maxillofac Surg. 2003;32(1):91–3.
Busquets JM, Rullan PJ, Trinidad-Pinedo J. Bilateral chylothorax after neck dissection. Otolaryngol Head Neck Surg. 2004;130(4):492–5.
Srikumar S, Newton JR, Westin TA. Bilateral chylothorax following left-sided radical neck dissection. J Laryngol Otol. 2006;120(8):705–7.
Tsukahara K, Kawabata K, Mitani H, Yoshimoto S, Sugitani I, Yonekawa H, et al. Three cases of bilateral chylothorax developing after neck dissection. Auris Nasus Larynx. 2007;34(4):573–6.
Bae JS, Song BJ, Kim MR, Park WC, Kim JS, Jung SS. Bilateral chylothoraces without chyle leakage after left sided neck dissection for thyroid cancer: report of two cases. Surg Today. 2007;37(8):652–5.
Han C, Guo L, Wang KJ, Zhao JQ. Bilateral chylothorax following neck dissection for thyroid cancer. Int J Oral Maxillofac Surg. 2009;38(10):1119–22.
Khurana H, Mishra S, Jain R, Goyal GN, Bhatnagar S. Management of postoperative chylothorax in a patient with carcinoma of thyroid and lymphadenopathy. A case report. Middle East J Anesthesiol. 2009;20(1):121–3.
Thawley SE. “How I do it”—head and neck. A targeted problem and its solution. Chylous fistula prevention and management. Laryngoscope. 1980;90:522–5.
Spiro JD, Spiro RH, Strong EW. The management of chyle fistula. Laryngoscope. 1990;100(7):771–4.
Stringel G, Mercer S, Bass J. Surgical management of persistent postoperative chylothorax in children. Can J Surg. 1984;27(6):543–6.
Hugges RL, Mintzer RA, Hidvegi DF, Freinkel RK, Cugell DW. The management of chylothorax: clinical conference in pulmonary diseases from North Western University Medical School, Chicago. Chest. 1979;76:212–8.
Rahman NM, Chapman SJ, Davies RJ. Pleural effusion: a structured approach to care. Br Med Bull. 2005;72:31–47.
Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc. 1980;55(11):700–4.
Sassoon CS, Light RW. Chylothorax and pseudochylothorax. Clin Chest Med. 1985;6:163–71.
de Beer HG, Mol MJ, Janssen JP. Chylothorax. Neth J Med. 2000;56(1):25–31.
Valentine VG, Raffin TA. The management of chylothorax. Chest. 1992;102:586–91.
Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ. Octreotide in the treatment of thoracic duct injuries. Am Surg. 2000;66(12):1165–7.
Al-Zubairy SA, Al-Jazairi AS. Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother. 2003;37(5):679–82.
Rimensberger PC, Müller-Schenker B, Kalangos A, Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg. 1998;66(1):253–4.
Chan SY, Lau W, Wong WH, Cheng LC, Chau AK, Cheung YF. Chylothorax in children after congenital heart surgery. Ann Thorac Surg. 2006;82(5):1650–6.
Jiang HJ, Wang CL, Zhao ZQ, Li XL, Qi DL, Gong LQ. Treatment strategy for chylothorax after resection for lung cancer—16 case report. Chin J Clin Oncol. 2006;3:158–61.
Boffa DJ, Sands MJ, Rice TW, Murthy SC, Mason DP, Geisinger MA, et al. A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery. Eur J Cardiothorac Surg. 2008;33(3):435–9.
Litherland B, Given M, Lyon S. Percutaneous radiological management of high-output chylothorax with CT-guided needle disruption. J Med Imaging Radiat Oncol. 2008;52(2):164–7.
Selle JG, Snyder WH, Schreiber JT. Chylothorax: indications for surgery. Ann Surg. 1973;177:245–9.
Merrigan BA, Winter DC, O’Sullivan GC. Chylothorax. Br J Surg. 1997;84(1):15–20.
Paes ML, Powell H. Chylothorax: an update. Br J Hosp Med. 1994;51(9):482–90.
Paul S, Altorki NK, Port JL, Stiles BM, Lee PC. Surgical management of chylothorax. Thorac Cardiovasc Surg. 2009;57(4):226–8.
Conflict of interest
All authors report no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tian, W., Li, ZY., Wang, P. et al. Chylothorax after neck dissection for thyroid carcinomas: report of three cases. Surg Today 42, 89–92 (2012). https://doi.org/10.1007/s00595-011-0015-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-011-0015-6