Right video-assisted thoracoscopy thoracic duct ligation as treatment for a case of chyloptysis.
Xu RB, Crouch G, Jurisevic C, Stuklis RG.
J Thorac Cardiovasc Surg 2013 Jun;145(6):e64-5. doi: 10.1016/j.jtcvs.2013.02.029.
Abstract
A 71-year-old man presented with ongoing expectoration of milky, foul-tasting sputum, while denying any systemic symptoms. He first presented in 2007 with a type B dissection with an aneurysmal complex. He underwent distal aortic arch repair via a left anterolateral thoracotomy approach with femoral-femoral bypass via percutaneous cannulas. The distal aortic arch was transected and a 26-mm Dacron graft was sutured, with a distal anastomosis formed below the pulmonary hilum to the distal descending thoracic aorta.
Conclusions
Iatrogenic injury to the thoracic duct is not an uncommon consequence of thoracic cavity surgery. We present a case of such an injury after a distal aortic arch repair, with persistent chylothorax and chyloptysis as a consequence. Although the preference of the original treating surgeon was to attempt surgical correction via redo thoracotomy, in this case, right-assisted video-assisted thoracoscopy duct ligation was used as a successful conclusive treatment modality. Because video-assisted thoracic surgery has relatively low morbidity and cost, earlier use of this approach is supported by the literature.