title: Midodrine: a novel therapeutic for refractory chylothorax.
abstract: Thoracic duct injury is a rare but serious complication following surgery of the neck or chest that leads to uncontrolled chyle leak. Conventional management includes drainage, nutritional modification, or aggressive surgical interventions such as thoracic duct ligation, flap coverage, fibrin glue, or talc pleurodesis; few successful medical therapeutics are available. We report a case of a high-output chylothorax refractory to aggressive medical and surgical interventions. Chyle output decreased substantially after initiating midodrine, an α1-adrenergic agonist that causes vasoconstriction of the lymph system, reducing chyle flow. This case report suggests that midodrine may be a novel therapeutic for refractory chyle leaks.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Douglas Z
authors.initials: DZ
authors.lastname: Liou
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Heather
authors.initials: H
authors.lastname: Warren
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Dermot P
authors.initials: DP
authors.lastname: Maher
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Harmik J
authors.initials: HJ
authors.lastname: Soukiasian
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Melo
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Eric.Ley@cshs.org.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D002916:Chylothorax / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D013897:Thoracic Duct / Q000293:injuries* / Q000601:surgery; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008879:Midodrine