title: Life-threatening chylothorax after left internal mammary artery dissection: therapeutic considerations.
abstract: Persistent chylothorax developed in a 53-year-old man after left internal mammary artery (LIMA) takedown and required surgical intervention. After an unsuccessful supraclavicular approach, left-sided standard thoracotomy showed thick adhesions around the LIMA takeoff with a diffuse oozing rather than an identifiable discrete leak. A possible leaking point was stitched, the area was sealed with fibrin adhesive, and complete remission ensued. Operation for chylothorax after LIMA takedown is challenging. A left-sided standard thoracotomy with minimal dissection and use of fibrin adhesive rather than blind stitching are recommended.
mesh_terms: D007611:Aprotinin / Q000627:therapeutic use; D002916:Chylothorax / Q000209:etiology / Q000601:surgery*; D004338:Drug Combinations / Q000627:therapeutic use; D004630:Emergencies; D005176:Factor XIII / Q000627:therapeutic use; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013908:Thoracotomy / Q000379:methods; D013917:Thrombin / Q000627:therapeutic use; D000267:Tissue Adhesions / Q000601:surgery; D014014:Tissue Adhesives / Q000627:therapeutic use
chemical_list: D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D005340:Fibrinogen; D005176:Factor XIII; D007611:Aprotinin; D013917:Thrombin