title: Unusual cause of shortness of breath after surgery for thoracic outlet syndrome.
abstract: A 31-year-old postal worker was diagnosed with bilateral thoracic outlet syndrome and scheduled for the first of two surgeries. The first procedure involved removal of the right first cervical rib, anterior and middle scalenes. On postoperative day 4, he developed shortness of breath. Chest radiograph showed a new pleural effusion on the right. Thoracentesis revealed a yellowish-red thick effusion. Based on the initial look of the fluid it was thought to be a haemorrhagic effusion with a purulent component, further testing revealed that he had developed a chylothorax. The patient was placed on a medium-chain triglyceride diet followed by chest tube drainage. After one day, the chest tube was removed due to minimal drainage, and he was discharged home the next day. Keeping this patient without food, on total parental nutrition, or pursuing surgical intervention was not necessary, as he had an excellent outcome from a very rare surgical complication.
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, Atlantis, FL, USA. jschroeder@med.miami.edu
authors.forename: Jonathan Ryan
authors.initials: JR
authors.lastname: Schroeder
authors.forename: Anjan
authors.initials: A
authors.lastname: Kumar
authors.forename: Edward
authors.initials: E
authors.lastname: Savage
authors.forename: Franck F
authors.initials: FF
authors.lastname: Rahaghi
mesh_terms: D000328:Adult; D015505:Chest Tubes; D002916:Chylothorax / Q000209:etiology* / Q000628:therapy; D004041:Dietary Fats / Q000008:administration & dosage; D004322:Drainage; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D013902:Radiography, Thoracic; D013901:Thoracic Outlet Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014280:Triglycerides / Q000008:administration & dosage
chemical_list: D004041:Dietary Fats; D014280:Triglycerides