|
|
|
| Transjugular intrahepatic portosystemic shunt for a patient with chylothorax in cryptogenic/metabolic cirrhosis |
| Francesco Cocomazzi a , Nicola Maurizio Castellaneta a , Antonino Castellaneta a , Fabio Fucilli b , Enzo Ierardi a , Alfredo Di Leo a , ∗ |
a Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
b Radiology Unit, IRCCS De Bellis, Castellana Grotte, Bari, Italy
∗ Corresponding author.
E-mail address: alfredo.dileo@uniba.it (A. Di Leo). |
|
|
|
|
Abstract Chylothorax is a rare pleural effusion with a milky appearance due to triglycerides and chylomicrons [1] ; About 1% of cases are associated with liver cirrhosis [2] . Incidentally, it has been hypothesized that chylothorax originates from the passage of chylous ascites into pleural cavity owing to diaphragmatic defects and negative thoracic pressure [3] . Chylous ascites represents the 1% of ascites in liver cirrhosis (1:20,0 0 0 hospitalizations) [4] . Pathophysiological mechanism is mediated by increased hepatic and gastrointestinal lymphatic flow due to portal hypertension [5] , which may lead to lymphatic vessel spontaneous rupture [6–8] . The gold standard for diagnosis of chylothorax is the presence of chylomicrons in the fluid [9 , 10] . If this analysis is not available, triglycerides concentration > 110 mg/dL is the diagnostic cut-off value. In addition, other diagnostic criteria include pleural/serum triglycerides ratio > 1 and pleural/serum cholesterol ratio < 1 [9] . In the case of liver cirrhosis, according to Light’s criteria, chylothorax is usually a transudate fluid [11] , which is defined by the absence of the following parameters: (a) pleural fluid/serum protein level > 0.5; (b) pleural fluid lactic/serum lactic acid dehydrogenase (LDH) level > 0.6; (c) pleural fluid LDH level > 2/3 upper serum normal limit [12] . Therapeutic approach can be both conservative and interventional. The objective of conservative treatment is lymphatic vessel spontaneous closure [10] . In cirrhotic patients, portal decompression may be a successful option [5,13] . A review of Tsauo et al. [5] reported that 7 patients with chylothorax and liver cirrhosis were treated with transjugular intrahepatic portosystemic shunt (TIPS). Despite the putative effectiveness, the small sample does not allow providing final recommendations about its use in first-line.
|
|
|
|
|
|
|
|
|
2020, Vol. 19 
