[Therapy of abdominal and thoracic chylous effusions 18 years after radiation therapy].
Chylothorax and chylascites are rare complications of neoplasm or surgical, but also non-surgical trauma. Extremely rare causes are a subclavian i.v. line, a mesenterical hamartoma, retrosternal goiter, liver cirrhosis, portal vein thrombosis, filariasis, tuberculosis, ruptured aortic aneurysm and radiotherapy. We report on a 60-year-old male with bilateral chylothorax and chylascites resistant to therapy 18 years after irradiation of the iliacal, paraaortal and mediastinal (46 Gray) and the left-sided supraclavicular (40 Gray) lymph nodes for a seminoma (T3N1M0 i.e. IIa, Lugano classification). A fat-free parenteral nutrition was started in order to bring the lymphatic flow down to a minimum. Chyle flow ceased after 3 1/2 weeks of treatment. An oral diet with middle chain triglycerides (MCT-diet), which are transported to the liver via the portal vein instead of the lymphatic system, achieved good control of residual chylous effusions.
Deist
T J
TJ
Kreiskrankenhaus Aschersleben, Innere Klinik II, Aschersleben. K-T.Deist@t-online.de
Freytag
A
A
D000596:Amino Acids / Q000008:administration & dosage; D002916:Chylothorax / Q000209:etiology / Q000628:therapy*; D002915:Chylous Ascites / Q000209:etiology / Q000628:therapy*; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage; D006801:Humans; D015182:Lymphatic Irradiation; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011832:Radiation Injuries / Q000209:etiology / Q000628:therapy*; D018239:Seminoma / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000532:radiotherapy*; D014280:Triglycerides / Q000008:administration & dosage
D000596:Amino Acids; D005950:Glucose Solution, Hypertonic; D014280:Triglycerides
Therapie abdomineller und thorakaler chylöser Ergüsse 18 Jahre nach Radiatio.