Chylothorax After Thoracic Surgery: How We Manage It

ABSTRACT Chylothorax is a rare but insidious condition, characterized by the accumulation of chyle in the pleural space, which is particularly common after cardiothoracic surgeries. It presents significant challenges in both diagnosis and treatment. In this technical report, we present our experienc...

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Main Authors: Alberto Busetto, Giorgio Cannone, Luigi Lione, Alessandro Bonis, Vincenzo Verzeletti, Michele Battistel, Alessandro Rebusso, Samuele Nicotra, Andrea Dell'Amore, Federico Rea
Format: Article
Language:English
Published: Wiley 2025-03-01
Series:Thoracic Cancer
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Online Access:https://doi.org/10.1111/1759-7714.70036
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author Alberto Busetto
Giorgio Cannone
Luigi Lione
Alessandro Bonis
Vincenzo Verzeletti
Michele Battistel
Alessandro Rebusso
Samuele Nicotra
Andrea Dell'Amore
Federico Rea
author_facet Alberto Busetto
Giorgio Cannone
Luigi Lione
Alessandro Bonis
Vincenzo Verzeletti
Michele Battistel
Alessandro Rebusso
Samuele Nicotra
Andrea Dell'Amore
Federico Rea
author_sort Alberto Busetto
collection DOAJ
description ABSTRACT Chylothorax is a rare but insidious condition, characterized by the accumulation of chyle in the pleural space, which is particularly common after cardiothoracic surgeries. It presents significant challenges in both diagnosis and treatment. In this technical report, we present our experience in managing four cases of postsurgical chylothorax, each one treated with a different approach. The first and second cases were successfully managed with Lipiodol lymphangiography, which allowed for the visualization and occlusion of the injured lymphatic duct, leading to the resolution of the chylothorax. The third case involved thoracic duct embolization, a procedure that resulted in the closure of the duct responsible for the chylous effusion. The last case involved a patient who developed left‐sided chylothorax following a pulmonary resection. The patient experienced chylous leakage early in the postoperative period and underwent a revision thoracoscopy for hemostasis and thoracic duct ligation. During the procedure, indocyanine green (ICG) fluorescence was used to effectively identify and ligate the injured chylous duct. This case series highlights the variety of therapeutic strategies available for the management of chylothorax, emphasizing the importance of a structured, stepwise approach tailored to the specific needs of each patient.
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spelling doaj-art-003b16ab3f024664bc6c78ca0075984f2025-08-20T02:53:13ZengWileyThoracic Cancer1759-77061759-77142025-03-01165n/an/a10.1111/1759-7714.70036Chylothorax After Thoracic Surgery: How We Manage ItAlberto Busetto0Giorgio Cannone1Luigi Lione2Alessandro Bonis3Vincenzo Verzeletti4Michele Battistel5Alessandro Rebusso6Samuele Nicotra7Andrea Dell'Amore8Federico Rea9Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyUniversity Radiology, Department of Medicine University Hospital of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyThoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova ItalyABSTRACT Chylothorax is a rare but insidious condition, characterized by the accumulation of chyle in the pleural space, which is particularly common after cardiothoracic surgeries. It presents significant challenges in both diagnosis and treatment. In this technical report, we present our experience in managing four cases of postsurgical chylothorax, each one treated with a different approach. The first and second cases were successfully managed with Lipiodol lymphangiography, which allowed for the visualization and occlusion of the injured lymphatic duct, leading to the resolution of the chylothorax. The third case involved thoracic duct embolization, a procedure that resulted in the closure of the duct responsible for the chylous effusion. The last case involved a patient who developed left‐sided chylothorax following a pulmonary resection. The patient experienced chylous leakage early in the postoperative period and underwent a revision thoracoscopy for hemostasis and thoracic duct ligation. During the procedure, indocyanine green (ICG) fluorescence was used to effectively identify and ligate the injured chylous duct. This case series highlights the variety of therapeutic strategies available for the management of chylothorax, emphasizing the importance of a structured, stepwise approach tailored to the specific needs of each patient.https://doi.org/10.1111/1759-7714.70036chylothoraxindocyanine green fluorescencelymphangiographylymphatic embolizationthoracic surgery
spellingShingle Alberto Busetto
Giorgio Cannone
Luigi Lione
Alessandro Bonis
Vincenzo Verzeletti
Michele Battistel
Alessandro Rebusso
Samuele Nicotra
Andrea Dell'Amore
Federico Rea
Chylothorax After Thoracic Surgery: How We Manage It
Thoracic Cancer
chylothorax
indocyanine green fluorescence
lymphangiography
lymphatic embolization
thoracic surgery
title Chylothorax After Thoracic Surgery: How We Manage It
title_full Chylothorax After Thoracic Surgery: How We Manage It
title_fullStr Chylothorax After Thoracic Surgery: How We Manage It
title_full_unstemmed Chylothorax After Thoracic Surgery: How We Manage It
title_short Chylothorax After Thoracic Surgery: How We Manage It
title_sort chylothorax after thoracic surgery how we manage it
topic chylothorax
indocyanine green fluorescence
lymphangiography
lymphatic embolization
thoracic surgery
url https://doi.org/10.1111/1759-7714.70036
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