Skip to main content

Advertisement

Log in

Chylothorax after neck dissection for thyroid carcinomas: report of three cases

  • Case Report
  • Published:
Surgery Today Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Vaiman M, Nagibin A, Olevson J. Complications in primary and completed thyroidectomy. Surg Today. 2010;40(2):114–8.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  CAS  Google Scholar 

  3. Stuart WJ. Operative injury of the thoracic duct in the neck. Edinb Med J. 1907;22:301–6.

    Google Scholar 

  4. Frazell EL, Harrold CC, Rasmussen L. Bilateral chylothorax: an unusual complication of radical neck dissection with recovery. Ann Surg. 1951;134(1):135–7.

    Article  PubMed  CAS  Google Scholar 

  5. Coates HL, DeSanto LW. Bilateral chylothorax as a complication of radical neck dissection. J Laryngol Otol. 1976;90(10):967–70.

    Article  PubMed  CAS  Google Scholar 

  6. Saraceno CA, Farrior RT. Bilateral chylothorax. Rare complication of neck dissection. Arch Otolaryngol. 1981;107(8):497–9.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. Ng RS, Kerbavaz RJ, Hilsinger RL Jr. Bilateral chylothorax from radical neck dissection. Otolaryngol Head Neck Surg. 1985;93(6):814–7.

    PubMed  CAS  Google Scholar 

  9. Pace-Balzan A, Moriarty B. Bilateral chylothorax following left radical neck dissection (case report). J Laryngol Otol. 1988;102(3):288–90.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. 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.

    CAS  Google Scholar 

  12. PJabbar AS, Al-Abdulkareem A. Bilateral chylothorax following neck dissection. Head Neck. 1995;17(1):69–72.

    Article  Google Scholar 

  13. Postma GN, Keyser JS. Management of persistent chylothorax. Otolaryngol Head Neck Surg. 1997;116(2):268–70.

    Article  PubMed  CAS  Google Scholar 

  14. Gregor RT. Management of chyle fistulization in association with neck dissection. Otolaryngol Head Neck Surg. 2000;122(3):434–9.

    Article  PubMed  CAS  Google Scholar 

  15. 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.

    PubMed  CAS  Google Scholar 

  16. Jortay A, Bisschop P. Bilateral chylothorax after left radical neck dissection. Acta Otorhinolaryngol Belg. 2001;55(4):285–9.

    PubMed  CAS  Google Scholar 

  17. 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.

    Article  PubMed  CAS  Google Scholar 

  18. Busquets JM, Rullan PJ, Trinidad-Pinedo J. Bilateral chylothorax after neck dissection. Otolaryngol Head Neck Surg. 2004;130(4):492–5.

    Article  PubMed  Google Scholar 

  19. Srikumar S, Newton JR, Westin TA. Bilateral chylothorax following left-sided radical neck dissection. J Laryngol Otol. 2006;120(8):705–7.

    Article  PubMed  CAS  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    PubMed  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. Spiro JD, Spiro RH, Strong EW. The management of chyle fistula. Laryngoscope. 1990;100(7):771–4.

    Article  PubMed  CAS  Google Scholar 

  26. Stringel G, Mercer S, Bass J. Surgical management of persistent postoperative chylothorax in children. Can J Surg. 1984;27(6):543–6.

    PubMed  CAS  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. Rahman NM, Chapman SJ, Davies RJ. Pleural effusion: a structured approach to care. Br Med Bull. 2005;72:31–47.

    Article  PubMed  Google Scholar 

  29. 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.

    PubMed  CAS  Google Scholar 

  30. Sassoon CS, Light RW. Chylothorax and pseudochylothorax. Clin Chest Med. 1985;6:163–71.

    PubMed  CAS  Google Scholar 

  31. de Beer HG, Mol MJ, Janssen JP. Chylothorax. Neth J Med. 2000;56(1):25–31.

    Article  PubMed  Google Scholar 

  32. Valentine VG, Raffin TA. The management of chylothorax. Chest. 1992;102:586–91.

    Article  PubMed  CAS  Google Scholar 

  33. 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.

    PubMed  CAS  Google Scholar 

  34. Al-Zubairy SA, Al-Jazairi AS. Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother. 2003;37(5):679–82.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  CAS  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  CAS  Google Scholar 

  40. Selle JG, Snyder WH, Schreiber JT. Chylothorax: indications for surgery. Ann Surg. 1973;177:245–9.

    Article  PubMed  CAS  Google Scholar 

  41. Merrigan BA, Winter DC, O’Sullivan GC. Chylothorax. Br J Surg. 1997;84(1):15–20.

    Article  PubMed  CAS  Google Scholar 

  42. Paes ML, Powell H. Chylothorax: an update. Br J Hosp Med. 1994;51(9):482–90.

    PubMed  CAS  Google Scholar 

  43. Paul S, Altorki NK, Port JL, Stiles BM, Lee PC. Surgical management of chylothorax. Thorac Cardiovasc Surg. 2009;57(4):226–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All authors report no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zhi-Yu Li.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-011-0015-6

Keywords

Navigation