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Thoracic Duct Obstruction
Obstruction Thoracic Duct

Presentation

The anomalies are organized by anatomical system and presented in a consistent manner, including details of the clinical presentation, epidemiology, embryology, treatment and prevention for each anomaly. [books.google.com]

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]

Entire Body System

  • Sepsis

    Patients should be warned to avoid trauma and to seek early and aggressive management of skin sepsis. Streptococci are the most common organisms causing cellulitis. [surgwiki.com]

    On day three, postoperatively she developed sepsis with multiorgan dysfunction. [lungindia.com]

    Figure 4 Chest roentgenogram on day 11 of admission shows almost complete resolution of right pleural effusion Subsequently, his clinical course was complicated with sepsis and pneumonia and as per family request he was transferred to hospice care where [ispub.com]

  • Collapse

    In both instances, one or more sections of the duct can collapse or become clogged, effectively shutting down the drainage process. When clogging occurs, the condition is often referred to as chylothorax. [wisegeek.com]

    […] flaplike minivalves. (2) Bundles of fine filaments anchor the endothelial cells to surrounding structures so that any increase in interstitial fluid volume separates the cell flaps, exposing gaps in the wall rather than causing the lymphatic capillary to collapse [quizlet.com]

  • Malaise

    CYANOSIS, CARDIAC MURMUR, DYSPNEA, FEVER, TACHYCARDIA, WEAKNESS Slow heart rate, heart sounds muffled, abdominal breathing, open mouth breathing, rapid shallow breaths, restrictive breathing pattern, cachexia, depression, dehydration, hypothermia, malaise [thecatclinic.com.au]

Respiratoric

  • Cough

    Most cases of idiopathic chylothorax in the adult are probably due to minor trauma, such as coughing or hiccupping, after the ingestion of fatty meals. [jacpjournal.org]

    Another alternative is to make extra mucous, which you will typically have to cough up in the morning (as well as after large meals). Because housecleaning is not working well, extra trash is left around your body, often in your joints. [wellnessresources.com]

    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]

    Traumatic causes can be either iatrogenic (e.g. surgery, radiation) or non-iatrogenic (e.g. penetrating or blunt trauma to the chest wall, forceful emesis or cough). [kenhub.com]

    These cysts are usually asymptomatic, although they sometimes cause clinical symptoms such as chest pain, dyspnea, dysphagia, cough or backache due to pressure of the surrounding structures ( 5 ). [atm.amegroups.com]

  • Tachypnea

    The mother and child then presented to the emergency department 2 days later for tachypnea and cyanosis, with diaphoresis and retractions exacerbated with feedings, while the child appeared more comfortable when upright. [thoracic.org]

Cardiovascular

  • Cyanosis

    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]

    The mother and child then presented to the emergency department 2 days later for tachypnea and cyanosis, with diaphoresis and retractions exacerbated with feedings, while the child appeared more comfortable when upright. [thoracic.org]

    Mild-to-moderate cyanosis of the hand. Dilated superficial collateral veins may be seen over the chest and upper arm - may be the only indicator in central venous cannulation. [patient.info]

  • Cardiomegaly

    Cardiomegaly – Enlargement of the heart. Cavernous lymphangioma – A deeply situated lymphangioma, composed of cavernous (hollow) lymphatic spaces, and always occurring in the neck or axilla. Cervicothorax – From neck to thorax. [lgdalliance.org]

    Her chest X-ray (CXR) revealed left side pleural effusion and cardiomegaly [Figure 1]. [jacpjournal.org]

  • Tachycardia

    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]

    Tachycardia, so pronounced in exophthalmic goitre, may be influenced through a disordered lymph system. [mcmillinmedia.com]

  • Hypotension

    I95.0 Idiopathic hypotension I95.1 Orthostatic hypotension I95.2 Hypotension due to drugs I95.3 Hypotension of hemodialysis I95.8 Other hypotension I95.81 Postprocedural hypotension I95.9 Hypotension, unspecified Reimbursement claims with a date of service [icd10data.com]

Neurologic

  • Confusion

    The histology of lymphangiomatosis resembles a lymphangioma ( Figure 8, Figure 9 ), but can appear to infiltrate tissues, and may be confused with more aggressive lesions. [phlebolymphology.org]

Workup

X-Ray

  • 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]

Treatment also includes skin care to prevent injuries, infection, and skin breakdown. Light exercise and movement programs may also be prescribed. [medlineplus.gov]

J Thorac Cardiovasc Surg 71:476–480 PubMed CAS Google Scholar Dugue L, Sauvent A, Farges O et al (1998) Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. [link.springer.com]

Prognosis

What is the treatment of choice and what is the likely longterm outcome (prognosis)? Surgical removal of the spleen is indicated. [quizlet.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]

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]

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]

We reviewed the literatures to find out the etiology, and we get done the contrast enhanced computed tomography (CECT-chest), venous Doppler of lower limb and deep neck veins and echocardiography. [jacpjournal.org]

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]

Due to mass effects or the direct invasion of disease into lymphatic vessels, thoracic malignancies such as neuroblastoma and lymphomas are the original etiology of some chylothoraces 1. [thoracic.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]

Epidemiology

The anomalies are organized by anatomical system and presented in a consistent manner, including details of the clinical presentation, epidemiology, embryology, treatment and prevention for each anomaly. [books.google.com]

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]

Epidemiology – The study of the various factors, patterns, and causes which determine the frequency of a disease on the human community. Etiology – The cause (s) or origin of disease. Also used as a parameter of classification. [lgdalliance.org]

Pathophysiology

Boccardo F, Bellini C, Eretta C et al (2007) The lymphatics in the pathophysiology of thoracic duct and abdominal surgical pathology: immunological consequences and the unexpected role of microsurgery. [link.springer.com]

Question 3 Which of the following statements regarding the pathophysiology of chylothorax is INCORRECT? Chylothoraces in premature babies can occur when there is compression of the main thoracic duct. [thoracic.org]

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]

The anomalies are organized by anatomical system and presented in a consistent manner, including details of the clinical presentation, epidemiology, embryology, treatment and prevention for each anomaly. [books.google.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]

In this situation of high intralymphatic pressure, lymphatic valves were not sufficiently strong to prevent backflow. [journals.lww.com]

Morotti M, Menada MV, Boccardo F, Ferrero S, Casabona F, Villa G, Campisi C, Papadia A (2013) Lymphedema microsurgical preventive healing approach for primary prevention of lower limb lymphedema after inguinofemoral lymphadenectomy for vulvar cancer. [link.springer.com]

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