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Correspondence |

Could Decortication Become Necessary in Cases of Pseudochylothorax? FREE TO VIEW

Levent Cansever, MD; Mehmet Ali Bedirhan, MD
Author and Funding Information

From the Department of Thoracic Surgery (Dr Cansever) and Department of Surgery (Dr Bedirhan), Yedikule Hospital for Chest Disease and Thoracic Surgery.

Correspondence to: Levent Cansever, Yedikule Hospital for Chest Disease and Thoracic Surgery, Yedikule Göğüs Hastaliklari Hastanesi, Istanbul, 34640 Turkey; e-mail: lcanserver@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):1023. doi:10.1378/chest.10-0282
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To the Editor:

We read the article by Wrightson et al (October 2009)1 with great interest. Pseudochylothorax is still an interesting entity in thoracic surgery because of its rarity and the uncertainty of its etiopathogenesis.2,3 In this article, Wrightson et al1 described the role of videothoracoscopy in checking the thickness of the pleura in patients with a known diagnosis resulting from pseudochylothorax. We suggest that videothoracoscopy is not necessary in this group of patients.

We previously performed thoracentesis to diagnose pseudochylothorax in five patients and performed underwater chest tube drainage. Pleural biopsy was performed in one patient who was admitted with no primary disease resulting from pseudochylothorax. Mean initial drainage was 1,100 mL/s. All patients recovered with conservative treatment, except one in whom pulmonary expansion could not be achieved, so that thoracotomy and decortication were necessary. These procedures were difficult and incomplete because of severe inflammation and thickening of the pleura. Multiple incisions were made over the pleura to expand the lobes.

In our experience, the pleura in patients with pseudochylothorax can either be thin or thick. These possibilities should be kept in mind when decortication becomes necessary. Also, we believe videothoracoscopy is not necessary in patients with known primary disease. We thank Wrightson and colleagues1 for sharing their experience and cases in their practices and providing an opportunity for us to discuss this rare entity.

Wrightson JM, Stanton AE, Maskell NA, Davies RJO, Lee YCG. Pseudochylothorax without pleural thickening: time to reconsider pathogenesis? Chest. 2009;1364:1144-1147. [CrossRef] [PubMed]
 
Miller JI.Shields TW. Anatomy of the thoracic duct and chylothorax. General Thoracic Surgery. 2005; Philadelphia, PA Lippincott Williams and Wilkins:879-888
 
Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006;737:1211-1220. [PubMed]
 

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References

Wrightson JM, Stanton AE, Maskell NA, Davies RJO, Lee YCG. Pseudochylothorax without pleural thickening: time to reconsider pathogenesis? Chest. 2009;1364:1144-1147. [CrossRef] [PubMed]
 
Miller JI.Shields TW. Anatomy of the thoracic duct and chylothorax. General Thoracic Surgery. 2005; Philadelphia, PA Lippincott Williams and Wilkins:879-888
 
Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006;737:1211-1220. [PubMed]
 
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