High-volume bilateral chylothorax presenting with hypoxemia and shock in a pediatric patient following tracheostomy revision: a case report.
BACKGROUND
Chylothorax is a rare complication of surgical neck dissection. This is the first reported pediatric case of bilateral chylothorax following cervical surgery and the first to occur after tracheoplasty. Chylothorax can lead to significant complications, including hypoxemia and shock, and requires timely treatment. This case report discusses the clinical presentation, diagnosis, and treatment of our patient and reviews possible pathophysiologic mechanisms to explain the development of postoperative bilateral chylous effusions.


METHODS
An 18-month-old white baby girl with a complex past medical history including choanal atresia, atrioventricular septal defect, failure to thrive, developmental delay, and tracheostomy dependence developed significant hypoxemia and shock following a routine tracehostomy revision. She was subsequently found to have developed massive bilateral chylothorax, requiring escalation of mechanical ventilation, thoracostomy tube drainage, vasoactive support, and eventual surgical ligation of her thoracic duct.


CONCLUSIONS
Massive bilateral chylothorax is a rare but potentially life-threatening complication following tracheoplasty. Clinicians caring for this patient population postoperatively should be aware of this potential complication and its management.
Department of Otolaryngology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA. aarlthat@med.umich.edu.
Aaron L
AL
Thatcher
Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA. janeyu@med.umich.edu.
Jane
J
Yu
Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA. kkevin@med.umich.edu.
Kevin W
KW
Kuo
D002916:Chylothorax / Q000175:diagnosis* / Q000628:therapy*; D004322:Drainage; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007223:Infant; D037981:Neck Dissection / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis*; D012086:Reoperation; D012769:Shock / Q000209:etiology; D013897:Thoracic Duct / Q000601:surgery; D055089:Tracheobronchomalacia / Q000601:surgery; D014139:Tracheostomy