Disorders of the Pleura |

Successful Autologous Blood Pleurodesis in Patients With Postoperative Chylothorax: A Case Report and Review of the Literature FREE TO VIEW

Mustafa Calik, MD; Hidir Esme, MD; Taha Bekci, MD; Saniye Goknil Calik, MD
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Konya Education and Research Hospital Department of Thoracic Surgery, Konya, Turkey

Chest. 2013;144(4_MeetingAbstracts):499A. doi:10.1378/chest.1704537
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SESSION TITLE: Pleural Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Sweating is an important mechanism in keeping the body temperature constant. Hyperhidrosis (HH) is a pathological condition of excessive secretion of the eccrine sweat glands in amounts greater than required for physiological needs. HH is more common in women and is usually bilateral and symmetrical. HH often begins in early childhood persists usually throughout adult life, and results in severe occupational emotional and socials handicaps [1]. Despite the prevalence of hyperhidrosis is thought to be insufficient; its prevalence has been reported as 2.8% in the United States and 4.9% in China [2]. Various treatment methods are recommended for the treatment of hyperhidrosis.Permanent management could be achieved through invasive techniques like sympathectomy [1].

CASE PRESENTATION: We report a healthy 23-year-old female with bilateral pronounced axillary hyperhidrosis, minimal hands sweating and bruising. Then bilateral thoracic sympathectomy was done for the management of HH. Patients who developed postoperative chylothorax were successfully treated with pleurodesis by autologous blood. It was completely successful in preventing fluid accumulation. In 6 months of follow-up, she had no further recurrence of effusion.

DISCUSSION: Cause of primary hyperhidrosis is unknown. Secondary hyperhidrosis may be a result of neurological or systemic disease such as pheochoromocytoma or thyrotoxicosis. The usual laboratory tests can help to rule out diseases causing secondary hyperhidrosis.The PH is more frequent in women and in palms, soles and axillae. Generally preferred treatment method, varies based on the clinician. Medical treatment is not effective. Anhidrosis is achieved in 95% of the patients who underwent surgical treatment[1]. Originally used for various other indications including epilepsy, glaucoma, angina pectoris, reflex sympathetic dystrophy and Raynaud’s phenomenon; sympathectomy as a treatment for HH was first reported in 1920. Endoscopic sympathectomy has practically replaced the open techniques. There is no doubt that thoracoscopic sympathetic surgery has provided a highly reliable solution for HH. The overall rate of complications is less than 5% and these are minor complications. The most important unwanted effect is reflex sweating, presented in 48% of the patients [2].Chylothorax is the accumulation of lymphatic fluid in pleural cavity due to ductus thoracicus and its lymphatic vessels damage. Postoperative chylothorax that developed after thoracic sympathectomy is a rare case and generally can be seen in the rate of 0.5 to 2.5% after cardiac and thoracic surgery. It can lead to respiratory insufficiency, immunodeficiency, protein loss, electrolite and fluid imbalance. Traditional conservative management of chylothorax has a failure rate of up to 48% especially in high output fistulae [3].

CONCLUSIONS: We presented a case of 23 years old female with ductus thoracicus injury as a result of thoracic sympathectomy. We have not found a similar case that postoperative chylothorax treated with pleurodesis by autologous blood in the literature. According to the anatomical variations, ductus thoracicus is open to injury even in the hands of an experienced surgeon. In case of injury was determined shortly after thoracic sympathectomy, autologous blood pleurodesis is an effective treatment for chylothorax. This procedure is safe, cheap and easily performed at the bedside.

Reference #1: Macía I, Moya J, Ramos R, Rivas F, Ureña A, Rosado G, Escobar I, Toñanez J, Saumench J. Primary hyperhidrosis. Current status of surgical treatment Cir Esp. 2010 Sep;88(3):146-51

Reference #2: Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg. 2009 Jun;137(6):1370-6

Reference #3: Kumar S, Kumar A, Pawar DK. Thoracoscopic management of thoracic duct injury: Is there a place for conservatism? J Postgrad Med. 2004 Jan-Mar;50(1):57-9.

DISCLOSURE: The following authors have nothing to disclose: Mustafa Calik, Hidir Esme, Taha Bekci, Saniye Goknil Calik

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