Quilotórax: A propósito de um caso clínico

 

Ricardo José Brito Pereira de Lima 1

Carla Cristina de Sousa Nogueira 1

Javier Porteiro Sanchez 2

Maria Teresa Shiang Tzer 3

Maria Manuela Queirós Rola 3

 

 

Resumo

O quilotorax caracteriza-se pela presença de linfa no espaço pleural devido a lesão ou obstrução do ducto torácico. O diagnostico e feito com base no elevado conteúdo de trigliceridos e na presença de quilomicrons.

A etiologia do quilotorax pode ser dividida em traumática e nao traumática. A ruptura traumática ocorre após acidentes ou cirurgias. Das causas não traumáticas, a mais comum e o linfoma e, na presença de um quilotorax de etiologia desconhecida, a primeira suspeita diagnostica devera ser dirigida para esta entidade, sendo o tipo mais frequente o nao Hodgkin.

Os autores apresentam o caso de um doente com quilotorax, cujo diagnóstico etiológico foi de linfoma nao Hodgkin, discutem os aspectos particulares do quilotorax, bem como a investigação e modalidades de tratamento desta entidade.

Palavras -chave: Quilotorax, empiema, pleurodese, toracoscopia, linfoma.

 

 

Chylothorax – Case report

Abstract

Chylothorax is the occurrence of lymph in the pleura due to damage or obstruction of the thoracic duct. High content of triglycerides and the presence of chylomicrons make the diagnosis of chylothorax. Its aetiology can be divided in traumatic and non-traumatic. Traumatic rupture occurs after accidents or surgery. Within non -traumatic aetiology, lymphoma is the most common and in the presence of a chylothorax of unknown origin this should be the first suspicion, being non -Hodgkin type the most frequent.

The authors present a case report of a patient with chylothorax due to non -Hodgkin lymphoma, discuss the particularities of chylothorax as well as the investigation and its treatment options.

Key-words: Chylothorax, empyema, pleurodesis, thoracoscopy, lymphoma.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliografia

1. Hillerdal G. Chylothorax and pseudochylothorax. Eur Respir J 1997;10:1157 -62.        [ Links ]

2. Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UBS, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc 1980;55:700 -4.

3. Loddenkemper R, Frank W. Pleural Disease. In: Gibson G, Geddes D, Costabel U, Sterk P, Corrin B (Eds.). Respiratory medicine. 3rd ed., London. Saunders; 2003: 1907 -1937.

4. Garcia -Zamalloa A, Ruiz -Irastorza G, Aguayo FJ, Gurrutxaga N. Pseudochylothorax. Report of 2 cases and review of the literature. Medicine (Baltimore) 1999;78:200.

5. Light RW. Chylothorax and pseudochylothorax. In: Pleural diseases, 5th ed. 2007:346 -61.

6. Doerr CH, Allen MS, Nichols III FC, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80(7):867 -70.

7. Hillerdal G. Effusions from lymphatic disruptions. In: Light RW, Lee YCG (Eds.). Textbook of pleural diseases. London; 2003:362 -7.

8. Shimizu K, Yoshida J, Nishimura M. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 2002;124:499 -502.

9. Alexandrakis MG, Passam FH, Kyriakou DS, Bouros D. Pleural effusions in hematologic malignancies. Chest 2004;125:1546 -55.

10. Prakash UBS. Chylothorax and pseudochylothorax. Eur Respir Mon 2002;7:249.

11. O´Callaghan A, Mead G. Chylothorax in lymphoma: mechanism and management. Ann Oncol 1995;6:603 -7.

12. Kalomenidis I. Octreotide and chylothorax. Cur Opin Pul Dis 2006;12:264 -7.

13. Andres AGC, Fernandez CM, Diez FJM, Gude VDH, Anton JAP, Nicolas JLM. Tratamiento conservador con octreotido del quilotorax posquirurgico. Arch Bronconeumol 2004;40(10):473 -5.

14. Weissberg D, Ben -Zeev I. Pleurodesis talc. Experience 360 patients. J Thorac Cardiovasc Surg 1993;106:689 -95.

15. Vargas FS, Milanez JRC, Filomeno LTB, Tarcisio L. Intrapleural talc for the prevention of recurrence in bening or undiagnosed pleural effusions. Chest 1994; 106:1771 -5.

16. Graham DD, McGahren ED, Tribble CG. Use of video -assisted thoracic surgery in the treatment of chylothorax. Ann Thorac Surg 1994;57:1507 -11.

17. Mares DC, Marthur PN. Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series. Chest 1998;114:731 -5.

18. Light RW. Is talc indicated for Pleurodesis? Journal of Bronchology 2002;9:228 -31.

19. Gyorik S, Erni S, Studler U, Hodek -Wuerz R, Tamm M, Chhajed P. Long -term follow -up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007;29:757 -60.

20. Sahn SA. Is talc Indicated for Pleurodesis? Journal of Bronchology 2002;9:223 -7.

21. Rodriguez -Panadero F, Antony VB. Pleurodesis: state of the art. Eur Respir J 1997;10(7):1648 -54.

22. Heffner JE. Diagnosis and management of chylothorax and cholesterol effusion. In: http://www.uptodate.com; 2008.

23. Vaz MAC, Fernandes PP. Quilotorax. J Bras Pneumol 2006;34(Supl 4):s197 -s203.

24. Little AG, Kadowaki MH, Fergunson MK, et al. Pleuroperitoneal shunting: alternative therapy for pleural effusion. Ann Surg 1988;48:195 -200.

 

 

1 Interno Complementar de Pneumologia

2 Interno Complementar de Medicina Interna

3 Assitente Graduada de Pneumologia

Centro Hospitalar de Vila nova de Gaia / Espinho EPE

 

Correspondência/Correspondence to:

Serviço de Pneumologia do Centro Hospitalar de Vila Nova de Gaia / Espinho

Directora de Serviço – Dra. Bárbara Parente

R. Conceição Fernandes

4430-000 Vila Nova de Gaia

E -mail: ricardo9lima@hotmail.com

 

 

Recebido para publicação/received for publication: 08.07.21

Aceite para publicação/accepted for publication: 08.12.31