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Transudative Chylothorax: Two Case Reports and Review of the Literature

滲出液乳糜胸:兩例病例報告及文獻回顧

摘要


乳糜胸是少見的病例而滲出液乳糜胸更是少見。不同於漏出液,滲出液乳糜胸最常見的病因是肝硬化、充血性心衰竭、腎病症候群及上腔靜脈阻塞。在此我們報告兩例滲出液乳糜胸:第一位是男性主述氣喘及端坐性呼吸三日,經過一系列檢查後發現是腎病症候群引起的乳糜胸。經低鹽飲食及利尿劑治療後,病患的情況好轉。第二位是主述漸近性氣喘兩個月的女性,在經肋膜穿刺及排除掉充血性心衰竭後,確定是肝硬化引起的乳糜胸。然而在經低鹽飲食及利尿劑治療後,病患的症狀仍然反覆發作。在此我們回顧滲出液乳糜胸的文獻並提醒臨床醫師在發現乳糜胸是滲出液時,勿作無謂的檢查。

並列摘要


Chylothorax is uncommon and transudative chylothorax is even rarer. In contrast to exudative chylothorax, the most common etiologies of transudative chylothorax are liver cirrhosis, congestive heart failure, nephrotic syndrome and superior vena cava thrombosis. We present 2 case reports of transudative chylothorax: The first case describes a man who had shortness of breath and orthopnea for 3 days, mimicking congestive heart failure. After a series of workups, nephrotic syndrome-related chylothorax was diagnosed, and diuretics and a low-salt diet were prescribed. No recurrence of dyspnea was noted during 1 year of followup. The second case involved a woman that suffered from progressive dyspnea for 2 months. After a thoracentesis study, we ruled out congestive heart failure and nephrotic syndrome. Liver cirrhosis-related chylothorax was later confirmed. However, the patient's symptoms recurred, even after receiving diuretic treatment and with low-salt diet control. We also reviewed the medical literature to remind clinicians of the importance of avoiding unnecessary workups if chylothorax is transudative.

並列關鍵字

transudate chylothorax nephrotic syndrome cirrhosis

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