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Thoracic Duct Obstruction


Presentation

  • Abstract A case is presented in which intermittent swelling of the face, left upper limb and both lower limbs was associated with steatorrhea. The thoracic duct was found to be obstructed at the thoracic outlet.[ncbi.nlm.nih.gov]
  • Case Presentation We present a 64 year-old male, with history of tobacco consumption of 50 pack-years. The symptoms of presentation were logic dysphagia.[austinpublishinggroup.com]
  • Peripheral lymphadenopathy can be found in more than two third of the patients with NHL and approximately 20% present with mediastinal adenopathy. Mediastinal involvement can be the sole presentation in primary NHL or as part of systemic disease.[ispub.com]
  • The clinical presentation, history and examination will usually suggest either of these conditions but each can be readily excluded by the use of duplex scanning of the lower limb venous system.[surgwiki.com]
  • Upcoming Presentations with Dr.[tosinfo.com]
Lymphedema
  • Documentation of the pathomechanisms of lymphedema in cases of severe anasarca in neonates is not often done. Here we document thoracic duct obstruction as the cause of lymphedema in a neonate with severe nonpitting generalized edema.[arizona.pure.elsevier.com]
  • Lymphedema risk reduction and management. In: Cheng MH, Chang DW, Patel KM, eds. Principles and Practice of Lymphedema Surgery. Philadelphia, PA: Elsevier; 2016:chap 9. Rockson SG. Lymphedema: evaluation and decision making.[medlineplus.gov]
  • Newborn with primary lymphedema. Figure 3. Primary lymphedema in both legs in an infant. Figure 4. Primary lymphedema in one upper limb in an infant.[phlebolymphology.org]
  • .- ) hereditary lymphedema ( Q82.0 ) Other noninfective disorders of lymphatic vessels and lymph nodes Approximate Synonyms Chyle leak of neck Chylothorax Chylous ascites Leakage of chyle of neck Lymphocele Lymphocele after procedure Postprocedural lymphocele[icd10data.com]
  • Obstruction of the thoracic duct(s) causes chronic lymphedema of the upper limb in patients presenting with symptoms of thoracic outlet syndrome: MRI/MRA/MRV pelvis Comments or suggestions? Contact the webmaster at [email protected][tosinfo.com]
Physician
  • […] study guide to help candidates pass clinical examinations in paediatrics, particularly at postgraduate level Examination Paediatrics, 4th Edition is written for candidates preparing for the Fellowship Examination of the Royal Australasian College of Physicians[books.google.com]
  • In recent years, some physicians have recommended utilizing this treatment as a precaution to a possible blockage due to some other surgery.[wisegeek.com]
  • View a list of physicians and other healthcare providers familiar with treating Thoracic Outlet Syndrome.[tosinfo.com]
  • Guyatt GH, Akl EA, Crowther M, et al ; Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.[patient.info]
Leg Swelling
  • Prognosis and results of treatment The majority of patients can control their leg swelling with compression stockings during the day and nocturnal elevation.[surgwiki.com]
Weight Loss
  • Aggressive lymphomas present acutely or subacutely with a rapidly growing mass, systemic B symptoms (ie, fever, night sweats, weight loss), and/or elevated serum LDH and uric acid.[ispub.com]
Anorexia
  • Clinical findings: ANOREXIA, ARRHYTHMIA, ASCITES, COUGHING, CYANOSIS, CARDIAC MURMUR, DYSPNEA, FEVER, TACHYCARDIA, WEAKNESS Slow heart rate, heart sounds muffled, abdominal breathing, open mouth breathing, rapid shallow breaths, restrictive breathing[thecatclinic.com.au]
Steatorrhea
  • Abstract A case is presented in which intermittent swelling of the face, left upper limb and both lower limbs was associated with steatorrhea. The thoracic duct was found to be obstructed at the thoracic outlet.[ncbi.nlm.nih.gov]
  • Ans is 'A' and will also be accompanied by steatorrhea and pleural effusion. plus some additional points: 1.[usmleforum.com]
Acute Abdomen
  • abdomen and new material on CT and MR angiography, lung cancer screening, pulmonary embolism, coronary artery calcium screening, and interventional CT techniques including radiofrequency ablation and CT fluoroscopy.[books.google.com]

Workup

Pericardial Effusion
  • Chylous pleural or pericardial effusion. Stake S, du Breuil AL, Close J ; Upper Extremity Deep Vein Thromboses: The Bowler and the Barista. Case Rep Vasc Med. 20162016:9631432. doi: 10.1155/2016/9631432. Epub 2016 Oct 9.[patient.info]
  • Other associated thoracic findings include pleural and rarely pericardial effusion. Pleural disease is seen in up to 10% of patients at the time of diagnosis (11).[ispub.com]

Treatment

  • , specific treatments including somatostatin, octreotide, sirolimus, and pleuroperitoneal shunt.( 7 ) Conservative treatment has an approximately 50 to 80 percent success rate in postoperative chylothorax, with higher success rates reported in patients[jtraumainj.org]
  • This treatment results in resolution of the chylothorax in 36-61% of cases [4,5]. In cases of high flow output chylothorax or failure of conservative treatment, reoperation is indicated as the next step.[austinpublishinggroup.com]
  • Treatment The treatment of lymphoedema is essentially conservative. Conservative treatment aims to preserve the quality of the skin, prevent lymphangitis and reduce limb size.[surgwiki.com]
  • In recent years, some physicians have recommended utilizing this treatment as a precaution to a possible blockage due to some other surgery.[wisegeek.com]
  • Treatment also includes skin care to prevent injuries, infection, and skin breakdown. Light exercise and movement programs may also be prescribed.[medlineplus.gov]

Prognosis

  • Prognosis Associated with significant morbidity and mortality due to potential risks of pulmonary embolism, post-thrombotic syndrome and loss of vascular access. About 10-20% develop pulmonary embolism [ 9 ].[patient.info]
  • Prognosis and results of treatment The majority of patients can control their leg swelling with compression stockings during the day and nocturnal elevation.[surgwiki.com]
  • Thoracic duct cysts are totally benign and carry an excellent prognosis after adequate surgical excision. No cases of malignant transformation have been reported so far ( 11 ).[atm.amegroups.com]
  • The prognosis in non-traumatic chylothorax is dependent on the underlying disease process and is worse in malignancy related chylothorax.[ispub.com]

Etiology

  • The clinical features of chylothorax depend on the rate of chyle accumulation in the pleural space as well as the concomitant effect of the etiology.[ispub.com]
  • Thoracic surgeries including esophagectomy or pulmonary resection are the usual etiologies, representing 80% of traumatic causes.( 2 ) Nonsurgical traumatic chylothorax can complicate central venous catheterization, pacemaker implantation, and chest trauma[jtraumainj.org]
  • Bugmann Etiology and management of pediatric chylothorax J Pediatr, 136 (2000), pp. 653-658 [Büttiker et al., 1999] V. Büttiker, S. Fanconi, R. Burger Chylothorax in children Guidelines for diagnosis and management.[apcontinuada.com]
  • Once chylothorax is confirmed, imaging studies are typically required to hunt for the etiology unless it is obvious.[lungindia.com]
  • THE ETIOLOGY OF LYMPHEDEMA An excess of interstitial fluid does not necessarily mean a malfunction of the lymphatic system as it is designed to cope with varying loads.[phlebolymphology.org]

Epidemiology

  • Epidemiology [ 1 ] There is a low incidence of about 1 per 100,000 people per year. 4-10% of all deep vein thromboses (DVTs) occur in the upper extremity.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Lymph Stasis: Pathophysiology, Diagnosis and Treatment. London: CRC Press; 1991:16-39. 3. Baluk P, Fuxe J, Hashizume H, et al. Functionally specialized junctions between endothelial cells of lymphatic vessels. J Exp Med. 2007;204:2349-2362. 4.[phlebolymphology.org]

Prevention

  • Most PICC procedures should ideally be guided by point-of-care bedside ultrasound (US), and this precaution may prevent malposition of PICC lines although it will not detect subsequent migration or extravasation.[arizona.pure.elsevier.com]
  • In this situation of high intralymphatic pressure, lymphatic valves were not sufficiently strong to prevent backflow.[journals.lww.com]
  • XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004: 27(1):155-161. ‎[books.google.es]
  • There are also two valves at the junction of the duct with the left subclavian vein, to prevent the flow of venous blood into the duct.[en.wikipedia.org]
  • The pleura becomes fibrosed and thickened causing atelectasis and preventing normal lung expansion.[thecatclinic.com.au]

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