A 25-yr-old woman presented with a right pleural effusion. Destruction of 9th through 12th ribs, adjacent vertebral bodies, and transverse processes was noted on plain radiograph and a large low-attenuated, irregular shaped mass lesion with peripheral rim enhancement, destroying vertebral body and transverse process, was revealed on the computed tomographic scan. Magnetic resonance imaging showed high signal on T1- weighted image and iso- and low signal on T2-weighted image for the mass lesion replacing the vertebral bony cortex and marrow space. An open rib biopsy revealed the histopathological changes of Gorham's disease (essential osteolysis), even though only bloody fluid filling the empty space and rib and vertebral transverse process destruction were grossly observed on operation. Even though there was no definite response to radiotherapy and pleurodesis, the patient showed stable condition up to 20 months after diagnosis.
Adult ; Chylothorax/complications/*pathology/radiotherapy ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Osteolysis, Essential/complications/*pathology/*radiotherapy ; Pleurodesis ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

We report a case of mediastinal lymphangioma associated with Gorham's disease in a 38-year-old man who had suffered recurrent clavicular fractures during a seven-year period. Mediastinal widening associated with osteolysis of the clavicles and the sternal manubrium was revealed by chest radiography, while computed tomography demonstrated a cystic anterior mediastinal mass infiltrating mediastinal fat and associated with osseous destruction of the clavicles and manubrium. Chylothorax recurred during the course of the disease.
Adult ; Case Report ; Chylothorax/*complications ; Human ; Lymphangioma/*complications/radiography ; Male ; Mediastinal Neoplasms/*complications/radiography ; Osteolysis, Essential/*complications/pathology/radiography ; Thoracic Vertebrae/*pathology ; Tomography, X-Ray Computed

Isolated pleural effusion, so called primary pleural effusion denotes a pleural effusion without documented etiology such as a cardiac, inflammatory, iatrogenic problem or fetal hydrops. Chromosomal anomaly such as Down syndrome may be associated with isolated pleural effusion. The content of the isolated pleural effusion is mostly chylous, and isolated non-chylous pleural effusion in neonate is rare. We experienced 2 cases of isolated non-chylous pleural effusion. They had neither cardiac problem nor other sign of hydrops fetalis. Imaging diagnosis was done by plain chest radiography and subsequent ultrasonogram. One of them was diagnosed to Down syndrome by karyotyping. They were fared well after diagnostic and therapeutic thoracentesis. We describe 2 cases of non-chylous pleural effusion and review a few English-language case reports of this entity.
Chyloperitoneum/pathology ; Chylothorax/pathology ; Down Syndrome/diagnosis/genetics ; Female ; Fetal Diseases/diagnosis/therapy ; Gestational Age ; Human ; Hydrothorax ; Infant, Newborn ; Karyotyping ; Male ; *Pleural Effusion ; Pregnancy ; Ultrasonography ; Ultrasonography, Prenatal

BACKGROUND: Due to its less invasive nature and superior visual field, video-assisted thoracoscopic excision of mediastinal mass is thought to be comparable to open thoracotomy. MATERIAL AND METHOD: From January 1995 to August 2001, the medical records of 38 patients who underwent video-assisted thoracoscopic excision of mediastinal mass was retrospectively analyzed. The outcome of these patients were compared with 5 patients who converted to thoracotomy. RESULT: Male to female ratio was 13(34.2%) : 25(65.8%), and mean age was 39.2 +/-35.4 years. Regarding the pathology, there were 8 neurilemmomas(21.1%), 6 thymic cysts (15.8%), 5 teratomas(13.2%), 5 ganglioneuromas(13.2%), 4 bronchogenic cysts(10.5%), 3 pericardial cysts(7.9%), 3 thymomas(7.9%), and 2 lymphangiomas(5.3%). The mean operation time was 110.6+/-7.0 minutes, mean postoperative tube stay was 4.2+/-0.4 days, mean postoperative hospital stay was 5.2+/-0.4 days, and mean number of injection of analgesics was 1.9+/-0.4 times. Although the mean values for the above indices were less than those of the thoracotomy conversion cases, they were statistically insignificant. Postoperative complications of video- assisted thoracoscopic excision included chylothorax, prolonged air leakage, and unilateral phrenic nerve palsy, all of which recovered before patient discharge. There was, however, permanent unilateral ptosis in one patient. CONCLUSION: As video-assisted thoracoscopic excision of mediastinal mass is safe, less painful, conducive to earlier recovery and cosmetically more appealing, a more active application of this technique is recommeded.
Analgesics ; Chylothorax ; Female ; Humans ; Length of Stay ; Male ; Mediastinal Cyst ; Mediastinal Neoplasms ; Medical Records ; Paralysis ; Pathology ; Patient Discharge ; Phrenic Nerve ; Postoperative Complications ; Retrospective Studies ; Thoracoscopy ; Thoracotomy ; Visual Fields

Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative management, including repeated thoracentesis or pleurodesis, seems to be suitable to most cases. Herein, we present a case of efficacious pleurodesis by intrapleural injection of Sapylin, a streptococcus preparation, for the treatment of chylothorax. A 52-year-old non-smoking female farmer was diagnosed as idiopathic chylothorax after we ruled out possible causes including chest trauma, lymphoma, lung cancer, filariasis, tuberculosis, and etc. Two-time intra-thoracic injection of 3 Klinische Einheit (KE) Sapylin achieved rapid and effective control of chylothorax with no severe side effects. Sapylin may facilitate pleurodesis by producing a strong inflammatory response.
Bacterial Vaccines ; therapeutic use ; Biological Products ; therapeutic use ; Chylothorax ; drug therapy ; pathology ; Female ; Humans ; Middle Aged ; Streptococcus ; chemistry ; Tomography, X-Ray Computed

OBJECTIVETo analyze the clinical characteristics and diagnosis of 2 cases with chylothorax due to primary lymphatic dysplasia and to elevate pediatrician's recognition level for this disease.

METHODClinical manifestations of the children were retrospectively analyzed. Primary lymphatic dysplasia was diagnosed by lymphoscintigraphy.

RESULTThe first patient was a male aged 2-year-7-month who presented with a history of tachypnea for 43 days, fever and sore throat for 5 days at the early stage of the illness. He had a history of external injury before his illness. Physical examination showed his left chest bulging and left side diminished breath sound. His pleural effusion showed dark red (It was divided into two layers after standing, the upper layer turned into milky white, and the lower turned into hemorrhagic liquid) . White blood cell (WBC) count was 9 000×10(6)/L, mononuclear cell was 0.9, polykaryocytes was 0.1, triglyceride was 12.37 mmol/L in the pleural effusion. Contrast-enhanced lung CT (revascularization) showed pericardial effusion and a massive left sided pleural effusion. The second patient was a male aged 9 years and 6 months, who presented with a history of cough for 24 days, intermittent fever, vomiting, abdominal pain for 19 days, and edema of lower limbs for 4 days. Physical examination showed edema in both eyelids, lower extremities and scrotum. The level of albumin was 14 g/L and the titer of Mycoplasma pneumoniae IgM was 1: 320 in the serum. His hydrothorax pleural effusion showed milk white. White blood cell (WBC) count was 74×10(6)/L, mononuclear cell was 0.78, polykaryocytes was 0.22, triglyceride was 1.01 mmol/L in the pleural effusion. Chyle test showed positive in his pleural effusion and seroperitoneum. High-resolution CT of the lung revealed bilateral interstitial and parenchymal infiltration and both sided pleural effusion. Abdominal ultrasound showed giant hypertrophy of the gastric mucosa and massive ascites. Gastroscopy showed giant hypertrophy of the gastric mucosa. Lymphoscintigraphy revealed primary lymphatic dysplasia in both children.

CONCLUSIONPrimary lymphatic dysplasia might occur in children and result in dropsy of serous cavity (chylothorax, chylopericardium, chylous ascites). Dropsy of serous cavity showed bloody or milk white. WBC count might elevate with lymphocyte increasing mostly, triglyceride was often higher than 1.0 mmol/L in dropsy of serous cavity. Primary lymphatic dysplasia can be diagnosed by lymphoscintigraphy.

Child ; Child, Preschool ; Chylothorax ; diagnosis ; etiology ; pathology ; Humans ; Leukocyte Count ; Lymphatic Abnormalities ; complications ; diagnosis ; pathology ; Lymphoscintigraphy ; Male ; Pericardial Effusion ; diagnosis ; etiology ; Pleural Effusion ; diagnosis ; etiology ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo investigate the safety, feasibility and the impact of different extents of lymph node dissection on the survival in the patients with locally advanced thoracic esophageal carcinoma.

METHODSFrom January 2001 to December 2006, 122 patients with locally advanced thoracic esophageal carcinoma underwent radical resection through cervical, thoracic, and abdominal incisions, and were randomly divided into two-field lymph node dissection group (Two-FD) and three-field lymph node dissection group (Three-FD). Life-table method was used to compare the difference of survival rates between the two groups. Kaplan-Meier method was used to compare the cumulative survival time and median survival time between the two groups. Multivariate analysis was performed using Cox model to identify the prognostic factors affecting the survival (alpha = 0.05).

RESULTSThere was no significant difference between the two groups in age, sex, and disease stage. Postoperative complication rate and perioperative mortality rate were 14.5% and 1.6% in the two-FD group versus 15.0% and 1.7% in the three-FD group, statistically without a significant difference (P > 0.05). The 1-, 3- and 5-year survival rates were 78.2%, 39.6% and 14.5% in the two-FD group, and 83.7%, 42.4% and 18.1% in the three-FD group, respectively. The median survival time was 24.0 months in the two-FD group and 31.0 months in the three-FD group. Log-rank analysis showed that in the patients without preoperative weight loss, in T3N1M0 stage, only single regional lymph node metastasis but < 3 in total, the three field lymph node dissection achieved a better prognosis (P < 0.05). Multivariate analysis using Cox model showed that T and N stages and lymph node dissection extent were still risk factors in patients with stage III locally advanced thoracic esophageal carcinoma.

CONCLUSIONCompared with the two field lymph node dissection, the three field lymph node dissection is safe and feasible, and can improve the survival for a part of stage III esophageal cancer patients without increase in operative mortality and complications.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Arrhythmias, Cardiac ; etiology ; Carcinoma, Squamous Cell ; pathology ; surgery ; Chemotherapy, Adjuvant ; Chylothorax ; etiology ; Cisplatin ; administration & dosage ; Esophageal Neoplasms ; pathology ; surgery ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Lymph Node Excision ; adverse effects ; methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Survival Rate