Mehmet Davutoğlu, Tahir Dalkıran, Mahmut Tokur, Yalçın Göksüğür Göksüğür, Kadir Söylemez, Fatih Karaokur

Spontan Şilotoraks (Bir Olgu Sunumu)

Şilotoraks, duktus torasikus ya da dallarının bozulması ya da tıkanıklığına bağlı olarak plevral aralığa şilöz sıvının sızmasıdır. Öncesinde herhangi bir yakınması bulunmayan 3,5 yaşında erkek hasta, öksürük ve hırıltılı solunum şikayetleriyle başvurdu. Akciğer grafisinde sol akciğerde konsolidasyon ile birlikte plevral efüzyon saptandı. Kapalı sualtı drenaja alınan hastanın efüzyon sıvısının görünümü süt beyaz renkte, pH 7, dansite 1015, trigliserit 2101 mg/dl, glikoz 168 mg/dl, lökosit 590 mm3 bulundu. Plevral efüzyon sıvısı kültüründe üreme olmadı. Bu bulgularla hastaya şilotoraks tanısı konuldu. Yağdan fakir diyetle birlikte somatostatin 3 μgr/kg/saat başlandı. Somatostatin tedavisine 2 hafta devam edilen hasta 25. günde toraks tüpü çıkarılarak taburcu edildi. Şilotoraksın çok nadiren de olsa spontan gerçekleşebileceği, tedavide somatostatin kullanımının cerrahi müdahale ihtiyacını azaltabileceği vurgulandı.

Anahtar Kelimeler:

Spontan Şilotoraks, Somatostatin, Göğüs Tüpü

-

Chylothorax is caused by the distruption or obstruction of the thoracic duct or its tributaries that result in leakage of chyle into the pleural space. A 3.5-year-old male patient without significant past medical history was admitted to the outpatient clinic of our hospital with persistent coughing. The initial chest radiograph demonstrated consolidation and effusion in the left lung upon which we performed thoracentesis. The pleural fluid had milk-white color. The biochemical analysis showed that its density was 1015 with pH: 7, glucose: 168 mg/dl, triglyceride: 2101 mg/dl, and WBC: 590/mm3. We started the treatment by offering a low-fat diet and somatostatin 3 μgr/kg/h. The chest tube was removed on the 25th day after the cessation of chylous pleural fluid from the tube in addition to the improvement that was visible on the chest radiograph; the patient was discharged. We would like to emphasize that chylothorax may occur very rarely but spontaneously and the use of somatostatin therapy may reduce the need for surgical intervention

Keywords:

-,

PDF

___

Townshend AP, Speake W, Brooks A. Chylothorax. Emerg Med J 2007;24:11.
Doerr CH, Allen MS, Nichols FC, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80:867-70.
Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C. Etiology and management of pediatric chylothorax. J Pediatr 2000;136:653–58.
Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009;10:199-207.
Bulbul A, Okan F, Nuhoglu A. Idiopathic congenital chylothorax presented with severe hydrops and treated with octreotide in term newborn. J Matern Fetal Neonatal Med 2009;22:1197-2000.
Cannizzaro V, Frey B, Bernet-Buettiker V. The role of somatostatin in the treatment of persistent chylothorax in children. Eur J Cardiothorac Surg 2006;30:49–53.
Paramés F, Freitas I, Fragata J, Trigo C, Pinto MF. Octreotide--additional conservative therapy for postoperative chylothorax in congenital heart disease. Rev Port Cardiol. 2009;28:799-807.
Moreira-Pinto J, Rocha P, Osório A, Bonet B, Carvalho F, Duarte C, Oliveira L. Octreotide in the treatment of neonatal postoperative chylothorax: report of three cases and literature review. 2011;27:805-10.
Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database.2010;(9):CD006388.
Buttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management. Chest 1999;116:682–87.
Panthongviriyakul C, Bines JE. Post-operative chylothorax in children: an evidencebased management algorithm. J Paediatr Child Health 2008;44:716–21.
Kumar A, Asaf BB, Chugh K, Talwar N. Thoracoscopic ligation of thoracic duct for spontaneous chylothorax. Indian Pediatr 2013;50:796-8.