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Der besondere Fall

Traumatischer Chylothorax beim stumpfem Thoraxtrauma

The special case

Traumatic chylothorax and spinal cord injury in blunt chest trauma

  • Thoraxchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Aufgrund der im hinteren Mediastinum geschützten prävertebralen Lage des Ductus thoracicus gilt die Inzidenz des traumatischen Chylothorax als Begleitverletzung beim stumpfen Thoraxtrauma als gering. Die enge topographische Beziehung des Ductus zur BWS erklärt jedoch andererseits die Koinzidenz von traumatischer Querschnittlähmung und traumatischem Chylothorax, wie sie von uns bei Unfällen mit großer Gewalteinwirkung auf die Wirbelsäule beobachtet wurde. Bei primär im Vordergrund stehender Diagnostik und Therapie der Querschnittsymptomatik oder anderer vital bedrohlicher Verletzungen wird der Chylothorax selbst häufig erst verzögert erkannt. Wir berichten deshalb anhand von 2 Fällen über die diagnostischen Fallstricke und die aktuellen konservativen und operativen Behandlungsoptionen beim traumatischen Chylothorax als Begleitverletzung der thorakalen Querschnittlähmung.

Abstract

Traumatic chylothorax is a rare result of closed thoracic trauma, mainly because the thoracic duct is fairly well protected in the posterior mediastinum. However, this position explains an obvious vulnerability to high-velocity accidents with fractures or hyperextensions of the thoracic spine. We describe two cases of multiple injured patients with traumatic chylothoraces and spinal cord injuries. As mentioned in almost all other case reports, we also observed a significant diagnostic delay. Fortunately, one fistula resolved spontaneously, but the other needed ligature of the thoracic duct. Because treatment of traumatic chylothorax often results in the need for prolonged intensive care, we discuss options to optimize diagnostic and therapeutic procedures.

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Hasse, W., Muwazi, E., Scholz, A. et al. Der besondere Fall. Trauma Berufskrankh 10, 77–83 (2008). https://doi.org/10.1007/s10039-008-1350-8

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  • DOI: https://doi.org/10.1007/s10039-008-1350-8

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