Massive Bilateral Chylothoraces Complicating Mediastinal Granulomatous Disease

doi:10.1016/j.athoracsur.2009.01.053

The Annals of Thoracic Surgery

Volume 88, Issue 3, September 2009, Pages 1012-1013

https://doi.org/10.1016/j.athoracsur.2009.01.053 Get rights and content

Mediastinal granulomatous disease with resulting fibrosis is known to cause several serious complications, including pulmonary artery occlusion, bronchial stenosis, superior vena cava syndrome, and constrictive pericarditis. This process is typically the result of an excessive fibrogenic response to the antigen of the fungus Histoplasma capsulatum. We present a case of a 20-year-old man who had massive bilateral chylothoraxes develop as a complication of mediastinal granulomatous disease. Aggressive surgical therapy was necessary to treat this potentially life-threatening condition with an excellent result.

Section snippets

Comment

Mediastinal granulomatous disease with resulting mediastinal fibrosis has been reported to cause several serious complications, including pulmonary arterial occlusion, bronchial stenosis, superior vena cava syndrome, and constrictive pericarditis [1]. This process is typically the result of an excessive fibrogenic response to the antigen of the fungus Histoplasma capsulatum, which is prevalent along the Mississippi River. However, isolation of the offending organism is rare in the majority of

References (4)

H.E. Garrett et al.
Surgical intervention in histoplasmosis
Ann Thorac Surg
(1986)
A.B. Carter et al.
Massive pleural effusion in diffuse granulomatous disease
Chest
(1997)

There are more references available in the full text version of this article.

Cited by (7)

Pulmonary Hypertension Caused by Fibrosing Mediastinitis
2022, JACC: Asia
Citation Excerpt :
TB-FM mainly involves the structures at bilateral hilar regions, such as PAs, bronchi, and PVs but rarely involves the SVC (Table 2). The clinical symptoms of PH-FM depend on the involved structures in the mediastinum2,6-8,25,28-40 (Table 3). In general, shortness of breath is the most frequent symptom of FM.8,25
Pulmonary hypertension (PH) is a progressive and severe disorder in pulmonary hemodynamics. PH can be fatal if not well managed. Fibrosing mediastinitis (FM) is a rare and benign fibroproliferative disease in the mediastinum, which may lead to pulmonary vessel compression and PH. PH caused by FM (PH-FM) is a pathologic condition belonging to group 5 in the World Health Organization PH classification. PH-FM has a poor prognosis because of a lack of effective therapeutic modalities and inappropriate diagnosis. With the development of percutaneous pulmonary vascular interventional therapy, the prognosis of PH-FM has been greatly improved in recent years. This article provides a comprehensive review on the epidemiology, pathophysiologic characteristics, clinical manifestations, diagnostic approaches, and treatment modalities of PH-FM based on data from published reports and our medical center with the goal of facilitating the diagnosis and treatment of this fatal disease.
Bilateral chylothorax after severe vomiting in a child
2012, Annals of Thoracic Surgery
Citation Excerpt :
Chylothorax is usually unilateral, whereas bilateral chylothorax is rare. Bilateral chylothorax can be caused by neck and upper mediastinum surgery, congenital factors, thoracic vertebral fracture, mediastinal infections, and factors that increase intrathoracic pressure [3, 4]. Pathologies such as Boerhaave syndrome, Mallory-Weiss syndrome, subcutaneous emphysema, pneumothorax, and hernia have been reported as the result of events that increase intrathoracic pressure, such as severe cough, severe vomiting, delivery maneuvers, and straining, but the rupture of ductus thoracicus following severe vomiting is rarely described.
In the etiology of chylothorax, traumas and malignancies are the first two leading causes. Today in pediatric patients, the most common cause of chylothorax includes the complications secondary to cardiothoracic operations. Bilateral chylothorax is rarely observed after severe vomiting leading to increase in intrathoracic pressure. In idiopathic chylothorax, bilateral localization is dominant. A 9-year-old girl who presented to our emergency department with the complaints of dyspnea and back pain following severe vomiting received a diagnosis of bilateral chylothorax. The patient was treated with the insertion of a bilateral chest tube, and pleurodesis was performed in left hemithorax. Examination did not reveal a pathology to this condition, except the vomiting observed 2 days previously after the meal.
Catheter based treatments for fibrosing mediastinitis
2019, Catheterization and Cardiovascular Interventions
Delayed right chylothorax after left blunt chest trauma: a case report
2017, Journal of Medical Case Reports
Bilateral chylothorax: Which is to blame?
2017, Gazi Medical Journal
Chylous ascites and chylothorax due to constrictive pericarditis in a patient infected with HIV: A case report
2012, Journal of Medical Case Reports

View all citing articles on Scopus

View full text

Case reportMassive Bilateral Chylothoraces Complicating Mediastinal Granulomatous Disease

Section snippets

Comment

Ann Thorac Surg

Chest

Case report
Massive Bilateral Chylothoraces Complicating Mediastinal Granulomatous Disease